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Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy

PURPOSE: Prostatic multi-parametric magnetic resonance imaging (mpMRI) has markedly improved the assessment of men with suspected prostate cancer (PCa). Nevertheless, as mpMRI exhibits a high negative predictive value, a negative MRI may represent a diagnostic dilemma. The aim of this study was to e...

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Autores principales: Artiles Medina, Alberto, Rodríguez-Patrón Rodríguez, Rafael, Ruiz Hernández, Mercedes, Mata Alcaraz, Marina, García Barreras, Silvia, Fernández Conejo, Guillermo, Fraile Poblador, Agustín, Sanz Mayayo, Enrique, Burgos Revilla, Francisco Javier
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2021
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486270/
https://www.ncbi.nlm.nih.gov/pubmed/34611522
http://dx.doi.org/10.2147/RRU.S323823
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author Artiles Medina, Alberto
Rodríguez-Patrón Rodríguez, Rafael
Ruiz Hernández, Mercedes
Mata Alcaraz, Marina
García Barreras, Silvia
Fernández Conejo, Guillermo
Fraile Poblador, Agustín
Sanz Mayayo, Enrique
Burgos Revilla, Francisco Javier
author_facet Artiles Medina, Alberto
Rodríguez-Patrón Rodríguez, Rafael
Ruiz Hernández, Mercedes
Mata Alcaraz, Marina
García Barreras, Silvia
Fernández Conejo, Guillermo
Fraile Poblador, Agustín
Sanz Mayayo, Enrique
Burgos Revilla, Francisco Javier
author_sort Artiles Medina, Alberto
collection PubMed
description PURPOSE: Prostatic multi-parametric magnetic resonance imaging (mpMRI) has markedly improved the assessment of men with suspected prostate cancer (PCa). Nevertheless, as mpMRI exhibits a high negative predictive value, a negative MRI may represent a diagnostic dilemma. The aim of this study was to evaluate the incidence of positive transperineal saturation biopsy in men who have negative mpMRI and to analyse the factors associated with positive biopsy in this scenario. PATIENTS AND METHODS: A retrospective study of men with normal mpMRI and suspicion of PCa who underwent saturation biopsy (≥20 cores) was carried out. A total of 580 patients underwent transperineal MRI/transrectal ultrasound fusion targeted biopsies or saturation prostate biopsies from January 2017 to September 2020. Of them, 73 had a pre-biopsy negative mpMRI (with Prostate Imaging – Reporting and Data System, PI-RADS, ≤2) and were included in this study. Demographics, clinical characteristics, data regarding biopsy results and potential predictive factors of positive saturation biopsy were collected. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for MRI-invisible PCa. RESULTS: The detection rate of PCa with saturation biopsy in patients with negative MRI was 34/73 (46.58%). Out of 34 MRI-invisible prostate cancers detected, 12 (35.29%) were clinically significant PCa (csPCa) forms. Regarding factors of positive biopsy, in univariate analysis, the use of 5-alpha reductase inhibitors and free:total prostate-specific antigen (PSA) ratio were associated with the result of the saturation biopsy. In multivariate analysis, only an unfavourable free:total PSA ratio remained a risk factor (OR 11.03, CI95% 1.93–63.15, p=0.01). Furthermore, multivariate logistic analysis demonstrated that prostate volume >50mL significantly predicts the absence of csPCa on saturation biopsy (OR 0.11, 95% CI 0.01–0.94, p=0.04). CONCLUSION: A free:total PSA ratio <20% is a risk factor for MRI-invisible PCa. Saturation biopsy could be considered in patients with suspected PCa, despite having a negative MRI.
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spelling pubmed-84862702021-10-04 Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy Artiles Medina, Alberto Rodríguez-Patrón Rodríguez, Rafael Ruiz Hernández, Mercedes Mata Alcaraz, Marina García Barreras, Silvia Fernández Conejo, Guillermo Fraile Poblador, Agustín Sanz Mayayo, Enrique Burgos Revilla, Francisco Javier Res Rep Urol Original Research PURPOSE: Prostatic multi-parametric magnetic resonance imaging (mpMRI) has markedly improved the assessment of men with suspected prostate cancer (PCa). Nevertheless, as mpMRI exhibits a high negative predictive value, a negative MRI may represent a diagnostic dilemma. The aim of this study was to evaluate the incidence of positive transperineal saturation biopsy in men who have negative mpMRI and to analyse the factors associated with positive biopsy in this scenario. PATIENTS AND METHODS: A retrospective study of men with normal mpMRI and suspicion of PCa who underwent saturation biopsy (≥20 cores) was carried out. A total of 580 patients underwent transperineal MRI/transrectal ultrasound fusion targeted biopsies or saturation prostate biopsies from January 2017 to September 2020. Of them, 73 had a pre-biopsy negative mpMRI (with Prostate Imaging – Reporting and Data System, PI-RADS, ≤2) and were included in this study. Demographics, clinical characteristics, data regarding biopsy results and potential predictive factors of positive saturation biopsy were collected. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for MRI-invisible PCa. RESULTS: The detection rate of PCa with saturation biopsy in patients with negative MRI was 34/73 (46.58%). Out of 34 MRI-invisible prostate cancers detected, 12 (35.29%) were clinically significant PCa (csPCa) forms. Regarding factors of positive biopsy, in univariate analysis, the use of 5-alpha reductase inhibitors and free:total prostate-specific antigen (PSA) ratio were associated with the result of the saturation biopsy. In multivariate analysis, only an unfavourable free:total PSA ratio remained a risk factor (OR 11.03, CI95% 1.93–63.15, p=0.01). Furthermore, multivariate logistic analysis demonstrated that prostate volume >50mL significantly predicts the absence of csPCa on saturation biopsy (OR 0.11, 95% CI 0.01–0.94, p=0.04). CONCLUSION: A free:total PSA ratio <20% is a risk factor for MRI-invisible PCa. Saturation biopsy could be considered in patients with suspected PCa, despite having a negative MRI. Dove 2021-09-27 /pmc/articles/PMC8486270/ /pubmed/34611522 http://dx.doi.org/10.2147/RRU.S323823 Text en © 2021 Artiles Medina et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Artiles Medina, Alberto
Rodríguez-Patrón Rodríguez, Rafael
Ruiz Hernández, Mercedes
Mata Alcaraz, Marina
García Barreras, Silvia
Fernández Conejo, Guillermo
Fraile Poblador, Agustín
Sanz Mayayo, Enrique
Burgos Revilla, Francisco Javier
Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy
title Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy
title_full Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy
title_fullStr Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy
title_full_unstemmed Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy
title_short Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy
title_sort identifying risk factors for mri-invisible prostate cancer in patients undergoing transperineal saturation biopsy
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486270/
https://www.ncbi.nlm.nih.gov/pubmed/34611522
http://dx.doi.org/10.2147/RRU.S323823
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