Neoplasia, Cancer, Outcomes analysis, Observer performance, Diagnostic procedure, MR, Pelvis, Oncology, Genital / Reproductive system male
J. Ash-Miles, H. M. A. OBrien, P. Charters, S. HALDAR; Bristol/UK
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 was an elevated serum PSA (<15 ng/mL) within the previous 3 months,
suspicious digital rectal examination,
suspected organ confined stage T2 or lower on rectal examination or family history.
The PROMIS trial demonstrated MP-MRI prostate to have a sensitivity of 93% and a negative predictive value of 89% when diagnosing clinically significant cancer.
Clinically significant cancer was primarily defined as Gleason score ≥4 + 3 or a maximum cancer core length 6 mm or longer.
The secondary definition was Gleason ≥7 (≥3+4). A sensitivity of 88% and negative predictive value of 76% was demonstrated for Gleason 7 malignancy or greater.
The PROMIS trial findings suggest that using MP-MRI triage may allow 27% of men to avoid an unnecessary primary TRUS-biopsy and reduce morbidity due to 5% reduction in the diagnosis of clinically insignificant cancers4.
We reviewed the radiology and pathology of all false negative and false positive outcomes within our hospital; a urological tertiary referral centre,
then evaluated how the results of the PROMIS trial compare to our practice.
Our objective was to compare the PROMIS outcome data with that of everyday practice in a tertiary referral center.