Fiard, G;
Norris, JM;
Nguyen, TA;
Stavrinides, V;
Olivier, J;
Emberton, M;
Moore, CM;
(2020)
What to expect from a non-suspicious prostate MRI? A review = Que peut-on attendre d’une IRM prostatique non suspecte ? Une revue de la littérature.
Progrès en Urologie
, 30
(16)
pp. 986-999.
10.1016/j.purol.2020.09.012.
Preview |
Text
Stavrinides_What to expect from a non-suspicious prostate MRI? A review_AAM.pdf - Accepted Version Download (250kB) | Preview |
Abstract
BACKGROUND: Many guidelines now recommend multiparametric MRI (mpMRI) prior to an initial or repeat prostate biopsy. However, clinical decision making for men with a non-suspicious mpMRI (Likert or PIRADS score 1-2) varies. OBJECTIVES: To review the most recent literature to answer three questions. (1) Should we consider systematic biopsy if mpMRI is not suspicious? (2) Are there additional predictive factors that can help decide which patient should have a biopsy? (3) Can the low visibility of some cancers be explained and what are the implications? SOURCES: A narrative review was performed in Medline databases using two searches with the terms "MRI" and "prostate cancer" and ("diagnosis" or "biopsy") and ("non-suspicious" or "negative" or "invisible"); "prostate cancer MRI visible". References of the selected articles were screened for additional articles. STUDY SELECTION: Studies published in the last 5 years in English language were assessed for eligibility and selected if data was available to answer one of the three study questions. RESULTS: Considering clinically significant cancer as ISUP grade≥2, the negative predictive value (NPV) of mpMRI in various settings and populations ranges from 76% to 99%, depending on cancer prevalence and the type of confirmatory reference test used. NPV is higher among patients with prior negative biopsy (88-96%), and lower for active surveillance patients (85-90%). The PSA density (PSAd) with a threshold of PSAd<0.15ng/ml/ml was the most studied and relevant predictive factor used in combination with mpMRI to rule out clinically significant cancer. Finally, mpMRI-invisible tumours appear to differ from a histopathological and genetic point of view, conferring clinical advantage to invisibility. LIMITATIONS: Most published data come from expert centres and results may not be reproducible in all settings. CONCLUSION: mpMRI has high diagnostic accuracy and in cases of negative mpMRI, PSA density can be used to determine which patient should have a biopsy. Growing knowledge of the mechanisms and genetics underlying MRI visibility will help develop more accurate risk calculators and biomarkers.
| Type: | Article |
|---|---|
| Title: | What to expect from a non-suspicious prostate MRI? A review = Que peut-on attendre d’une IRM prostatique non suspecte ? Une revue de la littérature |
| Location: | France |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.purol.2020.09.012 |
| Publisher version: | https://doi.org/10.1016/j.purol.2020.09.012 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions. |
| Keywords: | Magnetic resonance imaging, Negative predictive value, Prostate biopsy, Prostate cancer, Risk factors, Valeur predictive negative |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10112914 |
Archive Staff Only
 |
View Item |
