How Effective is mpMRI at Detecting PCa in Biopsy-Naïve Patients?

Multiparametric magnetic resonance imaging (mpMRI) has a 90 percent area under the curve (AUC) for detecting clinically significant prostate cancer (csPCa), according to a new meta-analysis involving data from nearly 5,000 biopsy-naïve men.¹

For the meta-analysis, recently published in Academic Radiology, researchers reviewed data from 16 studies and a total of 4,973 patients. The mean prostate-specific antigen (PSA) level ranged between 5.2 to 13.7 ng/mL, according to the authors. The meta-analysis authors noted that 14 of the reviewed studies assessed PCa detection solely on a per-patient lesion basis.¹

The researchers found that mpMRI offered pooled sensitivity and specificity rates of 82 percent and 62 percent for prostate cancer (PCa) as well as an 81 percent AUC. For csPCa, mpMRI provides a sensitivity rate of 88 percent and a specificity rate of 64 percent, according to the meta-analysis authors.¹

“It’s evident that mpMRI exhibits a better diagnostic performance for csPCa compared to overall PCa detection. The primary objective of prostate MRI is indeed to detect csPCa and minimizing unnecessary biopsies, which holds greater significance for health-care providers,” wrote lead meta-analysis author Lei Yang, M.D., who is affiliated with the Department of Radiology at the Affiliated Hospital of Qingdao University and the Qingdao Women and Children’s Hospital in Qingdao, China, and colleagues.

The meta-analysis authors also noted that negative mpMRI results reduced PCa risk by 72 percent and csPCa risk by 80 percent.¹

“ … This knowledge will be really useful for patients and doctors who wanto know what to expect from positive and negative mpMRI results when deciding if a biopsy is needed,” noted Yang and colleagues. “Furthermore, incorporating clinical data, such as PSA or PSA density, into pre-biopsy mpMRI may effectively guide prostate biopsy decision-making, thereby minimizing unnecessary biopsies and reducing the likelihood of missing csPCa.”

(Editor’s note: For additional content on prostate cancer imaging, click here.)

Yang and colleagues also cautioned about variability with Gleason score (GS) thresholds utilized for defining csPCa. Citing the work of Ahmed and colleagues in the PROMIS study, the meta-analysis noted an 89 percent negative predictive value (NPV) for mpMRI when csPCa was defined as GS > 4+3 and a 76 percent NPV for those with a GS > 3 +4.²

“This distinction underscores that while mpMRI demonstrates a high NPV overall for csPCa, its performance can vary depending on the specific thresholds used to define clinically significant disease, particularly when considering different Gleason scores,” pointed out Yang and colleagues.

(Editor’s note: For related content, see “MRI Study Suggests Deep Learning Model Offers Equivalent Detection of csPCa as Experienced Radiologists,” “Study: mpMRI-Targeted Biopsies Offer Better Detection of Cribriform and Intraductal PCa than Systematic Biopsies” and “Study: PSMA PET/CT More Advantageous than MRI for Locoregional Staging of Prostate Cancer.”)

In regard to the limitations of the meta-analysis, the authors conceded the possibility of bias with respect to sensitivity and specificity rates given the varied biopsy techniques employed in the review studies. They acknowledged that seven studies were retrospective, and some studies had small sample sizes. The meta-analysis authors also noted the exclusion of studies that were not published in English.