UP-5 Identifying prostate cancer in men with non-suspicious multi-parametric magnetic resonance imaging of the prostate.
Thursday June 27, 2019 from
TBD
Presenter

Paul N Doan, Australia

Senior Resident Medical Officer

Westmead Hospital

Abstract

Identifying prostate cancer in men with non-suspicious multi-parametric magnetic resonance imaging of the prostate

Paul Doan1,2, John Lahoud1, Lawrence H Kim1,2, Manish I Patel1,2.

1Urology, Westmead Hospital, Sydney, Australia; 2Surgery, The University of Sydney, Sydney, Australia

Introduction: To formulate clinical pathways for identifying clinically significant prostate cancer
(csPC) and avoiding insignificant prostate cancer (isPC) in those without suspicious regions of interest on multi-parametric magnetic resonance imaging (mpMRI) of the prostate.

Methods: A retrospective review identified patients with negative mpMRI who underwent subsequent transperineal prostate biopsy across 2 centres. Patient characteristics and association with biopsy results were evaluated using univariate and multivariate regression analyses.

Results: A total of 144 patients were identified as having negative mpMRI and undergoing subsequent transperineal prostate biopsy. 18% (25/144) of the cohort were found to have csPC. Logistic regression analysis failed to identify statistically significant predictive factors. In this cohort, if all patients with PSA>3.0 were biopsied the least amount of csPC is missed, at 20% (5/25) however all isPC would be diagnosed. The least amount of isPC is diagnosed with a biopsy threshold of >15% from the ERSPC calculator with 20% (5/25) of isPC diagnoses made however only 10.5% (2/19) csPC would be diagnosed. Using PSA density threshold of >0.10ng/ml/ml an intermediate pathway is found where 52% (13/25) of csPC is diagnosed and 36% (9/26) of isPC is missed whilst 46% (66/144) would avoid biopsy.

Conclusion: False negative rates of prostate MRI for csPC are significant within our cohort at 18%. The decision to biopsy should be made in conjunction with a risk profile acceptable by the patient and clinician. The current study demonstrates that there is a need to balance the risk of missing csPC and harm of diagnosing isPC.


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