Diagnostic accuracy of three tesla biparametric magnetic resonance imaging of the prostate, prostate specific antigen density and their combination for the detection of clinically significant prostate cancer: Results from a retrospective study

Aim of the Study: We aimed to compare the diagnostic accuracy of three Tesla BiparametricMagnetic Resonance Imaging (bpMRI) of the prostate, Prostate Specific Antigen Density (PSA-D) and their combination for the detection of clinically significant Prostate Cancer (PCa). Materials and Methods: We performed a retrospective study. Patients with clinical suspicion of PCa and PSA value between 2.5 and 10 ng/dL who underwent three Tesla bpMRI and subsequent prostate biopsy in a single institution were included into the study. Patients with history of previous prostate biopsy were excluded. PSA-D value was calculated based on prostate volume obtained during bpMRI. PCa lesions with an International Society of Urological Pathology (ISUP) score = or >3 were considered clinically significant PCa. Sensitivity and specificity in detecting clinically significant PCa were determined for bpMRI, PSA-D, and their combination. Receiver operating characteristic (ROC) curves were calculated. A p < 0.05 was considered statistically significant. Results: A total of 114 patients who underwent bpMRI and prostate biopsy between January 2015 and September 2017 were included into the study. bpMRI imaging consisted of T2-weighted imaging and diffusion weighted imaging acquisitions (b-values 0, 400, 1500) and was evaluated with a Likert score based on PI-RADS v2. All patients received 16-core transrectal prostate biopsy by a single operator. The sensitivity of bpMRI ad PSA-D in detecting clinically significant PCawas 93% and 77%, respectively (p < 0.005). ROC curves analysis showed that area under the curve (AUC) of bpMRI, PSA-D and combinationwas 0.87, 0.79 and 0.91, respectively (Figure 1). Based on the results of ROC curves, combination showed no significant improvement versus bpMRI alone. Discussion: bpMRI has a greater sensitivity and similar specificity compared to the PSA-D in the detection of clinically significant PCa. bpMRI combined with PSA-D does not provide superior results compared to bpMR alone. Our analysis suggests a possible independent role for bpMRI in the detection of clinically significant PCa.