Long-Term Risk of Clinically Significant Prostate Cancer in Biopsy-Negative Patients With Baseline Biparametric Prostate MRI

Laura Parhiala; Juha Knaapila; Ivan Jambor; Janne Verho; Kari Syvänen; Hannu Aronen; Peter Boström; Otto Ettala

doi:10.1002/jmri.29668

Long-Term Risk of Clinically Significant Prostate Cancer in Biopsy-Negative Patients With Baseline Biparametric Prostate MRI

J Magn Reson Imaging. 2024 Nov 27. doi: 10.1002/jmri.29668. Online ahead of print.

Authors

Laura Parhiala^{1

2

3}, Juha Knaapila⁴, Ivan Jambor^{5

6

7}, Janne Verho⁵, Kari Syvänen^{1

2}, Hannu Aronen⁵, Peter Boström^{1

2}, Otto Ettala^{1

2}

Affiliations

¹ Department of Urology, University of Turku, Turku, Finland.
² Department of Urology, Turku University Hospital, Turku, Finland.
³ Department of Urology, Tampere University Hospital, Tampere, Finland.
⁴ Department of Urology, Kuopio University Hospital, Kuopio, Finland.
⁵ Department of Diagnostic Radiology, University of Turku, Turku, Finland.
⁶ Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland.
⁷ Enterprise Service Group-Radiology, Mass General Brigham, Boston, Massachusetts, USA.

PMID: 39601084
DOI: 10.1002/jmri.29668

Abstract

Background: The long-term prevalence of clinically significant prostate cancer (csPCa) in patients with initial negative prostate biopsy is unknown.

Purpose: To investigate the rate of csPCa of men with initial negative biopsy.

Study type: Retrospective analysis of prospectively collected data.

Population: A total of 197 men (mean age 63 years [SD ±6.98, range 29-79]) without csPCa on initial biopsy and available baseline biparametric prostate MRI (bpMRI).

Field strength/sequence: 3.0 T, turbo spin-echo T2-weighted (axial and sagittal) and three sets of diffusion-weighted imaging using single-shot spin-echo planar imaging (5 b-values 0-500 seconds/mm²; 2 b-values 0 and 1500 seconds/mm², and 2 b-values 0 and 2000 seconds/mm²).

Assessment: BpMRI was read using Prostate Imaging Reporting Data System (PI-RADS) v2.1. Systematic or targeted biopsy results served as reference standard.

Statistical tests: Continuous variables were compared using Kruskal-Wallis rank sum test. Categorical variables were compared using either Fisher's exact test or Pearson's chi-square test. Uni- and multivariate regression odds ratios (95% confidence interval) were used to study factors affecting csPCa being diagnosed during follow-up. Time to diagnosis of csPCa is calculated using the Kaplan-Meier method.

Results: Of 197 men, 74 (38%), 57 (29%), and 66 (34%) presented with PI-RADS 1-2, 3, and 4-5 findings in the baseline bpMRI. During the median follow-up of 52 months, 8.1%, 5.3%, and 18.2% of these men were diagnosed with csPCa, respectively. Baseline PI-RADS finding was the only factor that associated with csPCa found during the follow-up.

Data conclusion: Baseline bpMRI with PI-RADS scores 1-3 and initial biopsies negative of csPCa had low rate of csPCa during follow-up, which supports more conservative follow-up for them but further research with longer follow-up is warranted.

Level of evidence: 3 TECHNICAL EFFICACY: Stage 2.