Prediction of Clinically Significant Prostate Cancer Using Multiparametric MRI, Biparametric MRI, and Clinical Parameters.

Introduction: Multiparametric MRI (mpMRI) is gold standard for the primary diagnostic work-up of clinically significant prostate cancer (csPCa). The aim of this study was to assess the benefit of the perfusion sequence and the non-inferiority of an MRI without contrast administration (bpMRI) compared to mpMRI while taking clinical parameters into account.

Methods: In this retrospective, non-interventional study we examined MRI data from 355 biopsy-naïve patients, performed on a 3T MRI system, evaluated by a board-certified radiologist with over 10 years of experience with subsequent mpMRI-TRUS fusion biopsy.

Discussion: Only 16/355 (4.5%) patients benefited from dynamic contrast enhanced. In only 3/355 (0.8%) patients, csPCa would have been missed in bpMRI. BpMRI provided sensitivity and specificity (81.4%; 79.4%) comparable to mpMRI (75.2%; 81.8%). Additionally, bpMRI and mpMRI were independent predictors for the presence of csPCa, individually (OR: 15.36; p < 0.001 vs. 12.15; p = 0.006) and after accounting for established influencing factors (OR: 12.81; p < 0.001 vs. 6.50; p = 0.012). When clinical parameters were considered, a more balanced diagnostic performance between sensitivity and specificity was found for mpMRI and bpMRI. Overall, PSA density showed the highest diagnostic performance (area under the curve = 0.81) for the detection of csPCa.

Conclusion: The premise of the study was confirmed. Therefore, bpMRI should be adopted as soon as existing limitations have been lifted by prospective multi-reader studies.