Aims and objectives
Men with high serum prostate specific antigen (PSA) routinely undergo biopsy (TRUS or template) as part of the prostate cancer diagnostic pathway1.
Often clinically insignificant cancer will be detected.
Complications secondary to TRUS-biopsy include pain,
acute urinary retention and prostatitis2.
Published in 2017,
the PROMIS trial is a multicenter prospective paired cohort study evaluating the role of multiparametric MRI (MP-MRI) in the diagnosis of prostate cancer4.
Inclusion criteria wasan elevated serum PSA (<15 ng/mL) within the previous 3 months,
suspicious digital rectal examination,...
Methods and materials
All MP-MRI prostate scans performed between January and March 2018 for patients with a clinical suspicion of prostate cancer were reviewed.
Clinical suspicion of prostate cancer included those with an elevated age relatedserum PSA.Those with a known diagnosis of prostate cancer including those under active surveillance and those with a non-cancerous diagnosis such as infection were excluded.
The radiological MP-MRI images and report for each patient was reviewed including Prostate Imaging and Data Reporting System (PIRADS) score,
prostate density and 3-dimensional prostatic measurements....
A total of 296 patients were identified.
Of the 296 patients who received MP-MRI 296 (100%) of those scanned had T2 and DWI sequences 290 (98%) received Gadolinium.22 (7%) were technically limited scans either secondary to local metallic artefact i.e.
from a total hip replacement or secondary to patient claustrophobia.
229 (77%) of reporters provided a three-dimensional prostatic size in their report and 292 (99%) calculated a prostatic volume.
124 (42%) did not provide a PSA density in their report (17 of these were not...
In our tertiary referral centre,
the outcomes for patients presenting with an elevated PSA correlate favorably with the results from the PROMIS trial.
PROMIS suggested that 27% of patients can safely avoid a biopsy.In our centre 123 of 270 men were allocated PIRADS 1 or 2 and 90 (33%) did not undergo biopsy.
PROMIS demonstrated that 11% (17/158) of men with a negative MP-MRI had clinically significant cancer on biopsy.
In our centre,
123 patients were allocated PIRADS 1 & 2.
Of the 33 that...
Janice Ash-Miles,Consultant Radiologist.Clinical interest:Urology - prostate cancer,
ST2 Radiology Registrar,
ST2 Radiology Registrar,
ST6 Radiology Fellow,
We would like to acknowledge and thank Southmead Hospital Radiology Department for their valuable contribution to this project.
1.National Institute for Health and Care Excellence (2014)Prostate cancer: diagnosis and management(Clinical Guideline 175).
Available at: https://www.nice.org.uk/guidance/cg175 [Accessed 29 December 2018].
2.PROSTATE CANCER UK.
[ONLINE] Available at: https://prostatecanceruk.org/prostate-information/prostate-tests/prostate-biopsy.
[Accessed 28 December 2018].
Complications of transrectal ultrasound-guided prostate biopsy: impact of prebiopsy enema.Korean J Urol.
El-Shater Bosaily A,
Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study.Lancet2017 DOI:https://doi.org/10.1016/S0140-6736(16)32401-1
5.High grade PIN....