Which prostate cancers are undetected by multiparametric magnetic resonance imaging in men with previous prostate biopsy? an analysis from the PICTURE study

Title: Which prostate cancers are undetected by multiparametric magnetic resonance imaging in men with previous prostate biopsy? an analysis from the PICTURE study
Authors: Norris, JM
Simmons, LAM
Kanthabalan, A
Freeman, A
McCartan, N
Moore, CM
Punwani, S
Whitaker, HC
Emberton, M
Ahmed, HU
Item Type: Journal Article
Abstract: Background Multiparametric magnetic resonance imaging (mpMRI) has improved risk stratification for suspected prostate cancer in patients following prior biopsy. However, not all significant cancers are detected by mpMRI. The PICTURE study provides the ideal opportunity to investigate cancer undetected by mpMRI owing to the use of 5 mm transperineal template mapping (TTPM) biopsy. Objective To summarise attributes of cancers systematically undetected by mpMRI in patients with prior biopsy. Design, setting, and participants PICTURE was a paired-cohort confirmatory study in which men requiring repeat biopsy underwent mpMRI followed by TTPM biopsy. Outcome measurements and statistical analysis Attributes were compared between cancers detected and undetected by mpMRI at the patient level. Four predefined histopathological thresholds were used as the target condition for TTPM biopsy. Application of prostate-specific antigen density (PSAD) was explored. Results and limitations When nonsuspicious mpMRI was defined as Likert score 1–2, 2.9% of patients (3/103; 95% confidence interval [CI] 0.6–8.3%) with definition 1 disease (Gleason ≥ 4 + 3 of any length or maximum cancer core length [MCCL] ≥ 6 mm of any grade) had their cancer not detected by mpMRI. This proportion was 6.5% (11/168; 95% CI 3.3–11%) for definition 2 disease (Gleason ≥ 3 + 4 of any length or MCCL ≥ 4 mm of any grade), 4.8% (7/146; 95% CI 2.0–9.6%) for any amount of Gleason ≥ 3 + 4 cancer, and 9.3% (20/215; 95% CI 5.8–14%) for any cancer. Definition 1 cancers undetected by mpMRI had lower overall Gleason score (p = 0.02) and maximum Gleason score (p = 0.01) compared to cancers detected by mpMRI. Prostate cancers undetected by mpMRI had shorter MCCL than cancers detected by mpMRI for every cancer threshold: definition 1, 6 versus 8 mm (p = 0.02); definition 2, 5 versus 6 mm (p = 0.04); any Gleason ≥ 3 + 4, 5 versus 6 mm (p = 0.03); and any cancer, 3 versus 5 mm (p = 0.0009). A theoretical PSAD threshold of 0.15 ng/ml/ml reduced the proportion of patients with undetected disease on nonsuspicious mpMRI to 0% (0/105; 95% CI 0–3.5%) for definition 1, 0.58% (1/171; 95% CI 0.01–3.2%) for definition 2, and 0% (0/146) for any Gleason ≥ 3 + 4. Conclusions Few significant cancers are undetected by mpMRI in patients requiring repeat prostate biopsy. Undetected tumours are of lower overall and maximum Gleason grade and shorter cancer length compared to cancers detected by mpMRI. Patient summary In patients with a previous prostate biopsy, magnetic resonance imaging (MRI) overlooks few prostate cancers, and these tend to be smaller and less aggressive than cancer that is detected.
Issue Date: 1-Aug-2021
Date of Acceptance: 4-Jun-2021
URI: http://hdl.handle.net/10044/1/92014
DOI: 10.1016/j.euros.2021.06.003
ISSN: 2666-1691
Publisher: ELSEVIER
Start Page: 16
End Page: 24
Journal / Book Title: European Urology Open Science
Volume: 30
Copyright Statement: © 2021 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Sponsor/Funder: Wellcome Trust
Medical Research Council (MRC)
Medical Research Council (MRC)
Funder's Grant Number: 204998/Z/16/Z
WSST_P70374
EP/V520354/1
Keywords: Science & Technology
Life Sciences & Biomedicine
Urology & Nephrology
False-negative magnetic resonance imaging
Undetected cancer
Multiparametric magnetic resonance imaging
PICTURE study
Prostate cancer
MULTI-PARAMETRIC MRI
DIAGNOSTIC-ACCURACY
TUMOR VOLUME
GUIDELINES
PROMIS
False-negative magnetic resonance imaging
Multiparametric magnetic resonance imaging
PICTURE study
Prostate cancer
Undetected cancer
Science & Technology
Life Sciences & Biomedicine
Urology & Nephrology
False-negative magnetic resonance imaging
Undetected cancer
Multiparametric magnetic resonance imaging
PICTURE study
Prostate cancer
MULTI-PARAMETRIC MRI
DIAGNOSTIC-ACCURACY
TUMOR VOLUME
GUIDELINES
PROMIS
Publication Status: Published
Online Publication Date: 2021-06-15
Appears in Collections:Department of Surgery and Cancer



This item is licensed under a Creative Commons License Creative Commons