The influence of prostate‐specific antigen density on positive and negative predictive values of multiparametric magnetic resonance imaging to detect Gleason score 7–10 prostate cancer in a repeat biopsy setting

• DOI: 10.1111/bju.13619
• Publication Date: 2016-08-04T06:48:26Z
• Authors: Nienke L. Hansen; Tristan Barrett; Brendan Koo; Andrew Doble; Vincent Gnanaprag...; Anne Warren; Christof Kastner; Ola Bratt
• Keywords: Image-Guided Biopsy; Male; Biopsy, Needle; Prostate; Prostatic Neoplasms; prostate-specific antigen density; Middle Aged; Prostate-Specific Antigen; prostate cancer; image fusion; Magnetic Resonance Imaging; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; magnetic resonance imaging; transperineal biopsy; Humans; prostate biopsy; Neoplasm Grading; Aged; Retrospective Studies

ObjectivesTo evaluate the influence of prostate‐specific antigen density (PSAD) on positive (PPV) and negative (NPV) predictive values of multiparametric magnetic resonance imaging (mpMRI) to detect Gleason score ≥7 cancer in a repeat biopsy setting.Patients and MethodsRetrospective study of 514 men with previous prostate biopsy showing no or Gleason score 6 cancer. All had mpMRI, graded 1–5 on a Likert scale for cancer suspicion, and subsequent targeted and 24‐core systematic image‐fusion guided transperineal biopsy in 2013–2015. The NPVs and PPVs of mpMRIs for detecting Gleason score ≥7 cancer were calculated (±95% confidence intervals) for PSAD ≤0.1, 0.1–0.2, ≤0.2 and >0.2 ng/mL/mL, and compared by chi‐square test for linear trend.ResultsGleason score ≥7 cancer was detected in 31% of the men. The NPV of Likert 1–2 mpMRI was 0.91 (±0.04) with a PSAD of ≤0.2 ng/mL/mL and 0.71 (±0.16) with a PSAD of >0.2 ng/mL/mL (P = 0.003). For Likert 3 mpMRI, PPV was 0.09 (±0.06) with a PSAD of ≤0.2 ng/mL/mL and 0.44 (±0.19) with a PSAD of >0.2 ng/mL/mL (P = 0.002). PSAD also significantly affected the PPV of Likert 4–5 mpMRI lesions: the PPV was 0.47 (±0.08) with a PSAD of ≤0.2 ng/mL/mL and 0.66 (±0.10) with a PSAD of >0.2 ng/mL/mL (P < 0.001).ConclusionIn a repeat biopsy setting, a PSAD of ≤0.2 ng/mL/mL is associated with low detection of Gleason score ≥7 prostate cancer, not only in men with negative mpMRI, but also in men with equivocal imaging. Surveillance, rather than repeat biopsy, may be appropriate for these men. Conversely, biopsies are indicated in men with a high PSAD, even if an mpMRI shows no suspicious lesion, and in men with an mpMRI suspicious for cancer, even if the PSAD is low.