How to avoid to diagnose Prostate Cancer

Andrea Fandella1, Francesco Di Toma2
  • 1 Casa di Cura Giovanni XXIII, Divisione di Urologia (Monastier )
  • 2 Casa di Cura Giovanni XXIII, Divisione di Radiologia (Monastier )


Prostate cancer is the most common male cancer.
Nowadays we have a problem of over diagnosis of prostate cancer (PC).
A reference strategy that screens men aged 50 to 74 years annually with a PSA threshold for biopsy referral of 4 µg/L reduces the risk for prostate cancer death to 2.15%, with risk for overdiagnosis of 3.3%.
We have the duty to identified only the significant PC. PSA is not enough sensible to rule out latent PC. Pro2PSA and PHI (prostate health index can give us an hand, and Multi-parametric MRI (mp-MRI) may have a role in ruling-out clinically significant prostate cancer.
We decide to offer patients In grey zone of PSA (4-10 ng/ml) the possibility to test the PHI and whom PHI are under 40 could underwent mpMRI.

Methods and results

85 consecutive men with a mean age 67 years (range 40–76) and mean PSA 6.2ug/L (range 4.1–10) were evaluated between January and December 2011., after PHI the Mp-MRI (T1/T2, dynamic contrast enhancement and diffusion weighting, 1.5Tesla, pelvic phased array) was performed Each mp-MRI was reported. with knowledge of PSA and patient age, by two uro-radiologists expert in prostate MRI. Each prostate was divided into 4 regions of interest (ROI) and a score of 1 to 5 assigned to each ROI (1 – ‘no cancer’, 5 – ‘highly suspicious’). 60 patiens had a negative mpMRI they enter in a program of follow-up. 25 underwent trus guided biopsy for suspicious lesions.


In the 25 mpMRI lesion we found 19 tumors (16 Gleason 7 and 3 Gleason 6) at the first biopsy .
The 60 free patients the PSA at more than 12 months of follow up was stable in 55 (up and down of values without significance), in 5 the PSAv went up and we performed TRUS biopsy 2 Gleason 6 cancer were found
In this setting, low risk patients (PSA < 10 and PHI < The high negative predictive value for clinically significant cancer as defined suggests that mp-MRI may have a role in ruling-out clinically significant prostate cancer. This finding could be used to address the over-diagnosis burden from PSA screening by using mp-MRI as a triage test to identify men who could avoid a prostate biopsy.


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