mpMRI is helping to avoid unnecessary prostate biopsies in the diagnostic work-up of prostate cancer.

Abstract

INTRODUCTION: Multiparametric magnetic resonance imaging (mpMRI) of the prostate may have a role in prostate cancer diagnosis in reducing the need for prostate biopsies in selected patients. This change in practice has been occurring in the management of patients in a private group urology practice. MATERIALS & METHODS: A custom made REDCap electronic database was used to capture the results of patients who had a mpMRI between June 2013 and January 2016. Information collected included patient age, prostate-specific antigen, Prostate Imaging Reporting and Data System (PI-RADS) score, transperineal biopsy of the prostate (TPB) results and initial management. RESULTS: Of 473 patients undergoing mpMRI, 35 patients had PIRADS 1 and 224 patients PI-RADS 2. Only 37.1% and 33.9% of patients with PIRADS 1 and 2 had a subsequent biopsy, respectively. This is in contrast with 62.5% of PI-RADS 3, 95.8% of PI-RADS 4, and 87.2% of PIRADS 5 patients who went on to have a TPB. The 16 patients who had PIRADS 4 or 5 disease on mpMRI who did not have a TPB had multiple medical comorbidities. CONCLUSION: mpMRI is being used in current clinical practice to avoid biopsy in the diagnostic work-up of prostate cancer in selected patients. However, some patients with negative MRI will have significant disease and therefore those not undergoing a biopsy will need to be followed up closely.