Friedl A, et al. – This study was conducted to evaluate prostate cancer (PCa) detection and prediction by combining the in–bore MRI–guided transrectal targeted prostate biopsy (MRGB) with prostate–specific antigen (PSA) parameters and the prostate health index (PHI) in case of negative 12–core standard biopsy (SB). Following negative SB of the prostate, it was noted that the MRGB achieved an overall prostate cancer (PCa) detection rate of 55% in patients with prostate imaging reporting and data system (PI–RADS) 3 to 5 lesions. By considering PHI and PHI density (PHID) 82%/62% of unnecessary biopsies could have been avoided, failing to detect 31%/16% cancers.

Methods

• In this research, a sum of 112 males (2014–2016) underwent 3.0T multi–parametric MRI (mpMRI) and subsequent MRGB of Prostate Imaging Reporting and Data System (PI–RADS) lesions 3–5.
• They noted ancillary PSA parameters (PSA ratio [%fPSA], PSA density [PSAD]) and the PHI and PHI density (PHID).
• Thereafter, with these parameters in combination with MRGB PCa prediction was computed.

Results

• As evidence accumulates, the most common lesions biopsied were PI–RADS 4 (66%), in the peripheral zone (64%), in the mid (58%) and anterior (65%) section of the prostate and 13 (IQR 10–15) mm large.
• They found PCa was in 62 (55%) patients (28% Gleason Score ≥7). PSAD (0.15 vs. 0.21; p=0.0051), %fPSA (16 vs. 13; p=0.0191), PHI (45 vs. 69; p<0.0001), PHID (0.7 vs. 1.5; p<0.0001) and prostate volume (ml; 56 vs. 45; p=0.0073) were significantly different in patients without/with PCa.
• It was showed that PHI and PHID were the strongest predictors of PCa with an AUC of 0.79 and 0.77, respectively.
• Applying optimal thresholds of 59 and 0.79, they illustrated that PHI and PHID were 69%/84% sensitive and 82%/62% specific for PCa.