Prostate MRI Misses Nearly One Quarter of Clinically Significant Prostate Cancers

WASHINGTON, DC—Prostate MRI may be less reliable for ruling out clinically significant prostate cancer (csPCa) than previously published reports suggest, according to real-world study findings presented at the Society of Urologic Oncology’s 24th Annual Meeting.

The new study, based on data from the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry, demonstrated that multiparametric MRI (mpMRI) of the prostate has a negative predictive value (NPV) of 77% for csPCa, defined as Grade Group 2 or higher cancer. Prior research suggested that mpMRI has an NPV approaching 90%.

Data suggest that clinicians may miss a diagnosis of csPCa in 23% of men who have a negative MRI and do not undergo prostate biopsy, Alex Zhu, DO, of Michigan Medicine in Ann Arbor, and colleagues concluded in a poster presentation.

The study included 857 patients across 26 urology practices who underwent 871 prostate biopsies within 1 year of a negative mpMRI. Of these biopsies, 439 were performed in the biopsy-naïve setting and 432 while on active surveillance (AS). The patients had a mean age of 65 years and a median PSA level of 5.6 ng/dL.

The NPV for csPCa for the biopsy-naïve patients, those on AS, and the entire cohort was 80%, 75%, and 77%, respectively.

On multivariable analysis, a PSA density of 0.1 or higher was significantly associated with 5.1-fold greater odds of finding csPCa following a negative mpMRI. The investigators concluded that this PSA density threshold should be used for pursuing prostate biopsy following a negative mpMRI.

Reference

Zhu A, Srivastava A, Dhir A, et al. Negative predictive value of prostate MRI in real world practice: Results from a statewide surgical collaborative. Presented at: SUO 2023; November 28-December 1, Washington, DC. Poster 186.

This article originally appeared on Renal and Urology News