Comparison of the Diagnostic Performance of Multiparametric Prostate Magnetic Resonance Imaging Results with Classical Parameters for Prostate Carcinoma in Gray Zone Patients

Abstract

Objective: To compare the diagnostic value of prostate imaging-reporting and data system (mpMRI) version 2.0 with classical parameters for prostate cancer detection in gray zone patients with ultrasonography-guided prostate biopsy as a reference point. Materials and Methods: With the retrospective nature of the study, 438 biopsy-naïve patients in the gray zone with pre-biopsy mpMRI were reviewed. Ultrasonography-guided transrectal prostate biopsy was the reference point. Diagnostic performance of classical parameters compared with mpMRI results for prostate carcinoma and clinically significant prostate carcinoma. Results: The overall cancer detection rate was 30%. Prostate-specific antigen density, free/total prostate-specific antigen ratio, prostate volume, suspicious digital rectal examination, and mpMRI score >3 were independent predictors of clinically significant prostate carcinoma. Prostate-specific antigen density followed by free/total prostate-specific antigen ratio had the largest area under the curve values compared with mpMRI score >3 for prostate carcinoma and clinically significant prostate carcinoma. Conclusion: Classical parameters, prostate-specific antigen density, and f/t prostate-specific antigen ratio were still critical to deciding prostate biopsy in gray zone patients, in whom ultrasonography-guided transrectal prostate biopsy was used as a reference point. In centers where targeted fusion biopsies were unavailable, pre-biopsy mpMRI still had some benefits. However, biopsy decisions should be made according to each patient’s individual characteristics.

Keywords

• prostate
• biopsy
• multiparametric prostate magnetic resonance imaging
• prostate carcinoma