A study presented at the European Association of Urology 2019 (EAU19) last weekend has concluded that negative pre-biopsy multiparametric MRI (mpMRI) can reliably exclude significant prostate cancer (sPCa) when used in combination with low prostate-specific antigen density (PSAD).
Of 900 biopsy-naive attending Frimley Park Hospital from October 2015 to August 2018, 45 per cent (n=404) had a negative mpMRI. Prostate cancer (PCa) and sPCa were detected in 35 per cent (n=142) and 16 per cent (n=66), corresponding to a negative predictive value (NPV) of 65 per cent and 84 per cent, respectively.
Using a PSAD cutoff of 0.15 ng/mL/mL and 0.10 ng/mL/mL in combination with a negative mpMRI increased the NPV for sPCa to 89 per cent and 91 per cent, respectively.
Eight-six (21.3%) of patients with a negative mpMRI were managed with active surveillance. At one-year follow-up, 7.7 per cent had upstaging on repeat biopsy.
The authors concluded that a negative pre-biopsy mpMRI can reliably exclude sPCa when used in combination with a low PSAD. They suggest the use of novel biomarkers may improve the predictive value of mpMRI in the future.
EAU 2019 is taking place in Barcelona, Spain, and concludes today, Tuesday 19 March.