Diagnostic performance of magnetic resonance imaging and targeted biopsy results in men with indwelling urinary catheters: A propensity score matched study.

Introduction: We sought to evaluate multiparametric magnetic resonance imaging (mpMRI) findings and biopsy results in men with an indwelling catheter undergoing prostate cancer screening. mpMRI is central to the evaluation of prostate cancer. Little is known as to the effect of an indwelling urinary catheter on prostate mpMRI findings and the results of subsequent biopsies.

Methods: We retrospectively reviewed 5820 mpMRI exams performed from 2017-2023. Forty-eight patients underwent mpMRI with indwelling urinary catheter. Using propensity score matching, patients were matched 1:1 for age, pre-biopsy prostate-specific antigen (PSA), and prostate volume. Clinical characteristics, mpMRI findings, and targeted biopsy results were compared between the groups.

Results: After propensity score matching, clinical characteristics of the study groups did not differ significantly. Prostate Imaging-Reporting & Data System (PI-RADS) distribution did not show a significant difference (p=0.51); PI-RADS ≥3 lesions were identified in 20/48 patients with indwelling catheters (42%) and in 18/50 patients without catheters (36%). Among patients with a PI-RADS score ≥3, clinically significant prostate cancer (CSPC) was identified in 5/20 patients carrying catheters and 6/18 patients without catheters (p=0.152). A higher rate of any cancer was identified in patients without a catheter (67% vs. 35%, p=0.049). PSA >9.79 ng/ml predicted the finding of CSPC in patients carrying urinary catheters with PI-RADS ≥3 lesions.

Conclusions: Our findings suggest no significant difference in mpMRI findings and CSPC rates for patients with and without indwelling urinary catheters. Patients carrying urinary catheters suspected to harbor CSPC based on an elevated PSA level should undergo further evaluation, including mpMRI and biopsies when necessary before benign prostatic hyperplasia treatment.