The Additive Value of MRI Targeted Biopsy on Prostate Cancer Detection in Patients with Serum Prostate-specific Antigen 20-100 ng/mL and Normal Digital Rectal Examination

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Objectives: The study investigates whether multiparametric magnetic resonance imaging (mpMRI) targeted biopsy (MRI-TB) is necessary in the setting of prostate-specific antigen (PSA) 20-100 ng/mL and normal digital rectal examination (DRE). Materials and Methods:Patients undergoing MRI-TB and concomitant systematic biopsies (SB) with a PSA 20-100 ng/mL and normal DRE were retrospectively reviewed in Prostate Cancer Database of Turkish Urooncology Association.Pathological data of MRI-TB was compared to the SB data.All patients underwent mpMRI followed by transrectal/transperineal MRI-TB of any Prostate Imaging Reporting and Data System lesion and 12-core SB.The prostate cancer (PCa) and clinically significant PCa (csPCa) (grade group ≥2) detection on MRI-TB, SB and MRI-TB+SB were determined for all patients.A subgroup analysis of combined (MRI-TB+SB) group was also performed to identify performances of MRI-TB alone, SB alone and combination of MRI-TB+SB for the prediction of final pathology at radical prostatectomy (RP).Statistical significance was set at p<0.05.Results: In the study 65 patients were evaluated.Among them, 35 have PCa and 32 of them were csPCa.The detection rate of PCa for MRI-TB+SB, MRI-TB and SB were 53%, 46% and 36%, respectively, and csPCa detection rates were 49%, 41% and 33%, respectively.TB added 31.4% of any grade PCa and 31.25%csPCa detection over SB. csPCa detection rate improved with increased PSA density for TB.Among 15 patients who underwent RP, 6 patients were found to have csPCa on final pathology which went undetected or undergraded with SB biopsy initially.Conclusion: MRI-TB based on mpMRI presents a valuable addition to SB in patients with PSA 20-100 ng/mL and normal DRE.