Role of magnetic resonance spectroscopic imaging (MRSI) and dynamic contrast-enhanced MRI (DCE-MRI) in identifying prostate cancer in patients with prior negative prostate biopsy and high PSA levels: results from a single-centre, prospective series

Umberto Anceschi1, Alessandra Pizzo2, Carlo Molinari1, Giovanni Regine3, Carlo Parola1, Massimo Governatori1, Pasquale Gambardella1, Claudio Anceschi1
  • 1 Ospedale San Camillo-Forlanini, U.O.C. Urologia (Roma)
  • 2 Università degli Studi, U.O.C. Ginecologia (Siena)
  • 3 Ospedale San Camillo-Forlanini, U.O.C. Radiologia (Roma)

Objective

Aim of this study was to evaluate the role of magnetic resonance spectroscopic imaging (MRSI) and dynamic
contrast-enhanced magnetic resonance imaging (DCE-MRI) in PCa in patients with elevated prostate-specific antigen
(PSA) and negative transrectal ultrasonography (TRUS)-guided biopsy.

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Methods and results

Materials and methods
This prospective study was conducted on 238 patients who underwent MRSI and DCE-MRI and targeted biopsies of
suspicious areas on MRI associated with random biopsies. Sensitivity, Specificity, Positive and Negative Predictive
Value were estimated. A logistic regression model was applied setting positivity to PCa and Primary Gleason Point
score as dependent variables, respectively. DC-MRI and MRSI positivity, PSA Value, Choline Citrate Ratio, total
number of prostate cores were included as independent variables.

Results
After the second biopsy, the diagnosis of prostate adenocarcinoma was made in 89/238 cases (37,3%). On a
per-patient basis, MRSI showed 92.1% sensitivity, 50.5% specificity, 73% positive predictive value (PPV), 81.6%
negative predictive value (NPV) and 74.2% diagnostic accuracy. The sensitivity, specificity, PPV, NPV and accuracy
for DCE-MRI was 76.5%, 89.5%, 84.5%, 83.7% and 82%, respectively. The combination of MRSI and DCE-MRI yielded
89.4% sensitivity, 90.7% specificity, 78.2% PPV, 96.6% NPV and 83.9% accuracy in detecting prostate carcinoma.
At a univariate and multivariate logistic regression analysis both DCE-MRI and MRSI were significant predictors of
prostate cancer in the final specimen (p=0.0002; p=0.0046). No correlation between primary and secondary Gleason
Score and Choline/Citrate ratio was found (p=0.0007)

Discussion

Discussion
In contrast with most recent findings, the role of combined study with MRSI and DCE-MRI in guiding the TRUS
prostate rebiopsy in patients with an initial PCa negative prostate biopsy still remains investigational, according to
our experience.

Conclusion
Further evidence from ongoing trials comparing MRSI/DCEMR TRUS directed biopsy with a saturation biopsy
procedure is strongly advocated.

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