Presentation Authors: Niranjan Sathianathen*, Minneapolis, MN, Altan Omer, Oxford, United Kingdom, Caroline Moore, Veerapan Kasivisvanathan, London, United Kingdom, Roderick van den Bergh, Utrecht, Netherlands, Shonit Punwani, London, United Kingdom, Christof Kastner, Tristan Barrett, Cambridge, United Kingdom, Declan Murphy, Melbourne, Australia, James Catto, Sheffield, United Kingdom, Ruth MacPherson, Fergus Gleeson, Richard Bryant, Freddie Hamdy, Oxford, United Kingdom, Hashim Ahmed, London, United Kingdom, Alastair Lamb, Oxford, United Kingdom
Introduction: Pre-biopsy multi-parametric MRI (mpMRI) is increasingly used in prostate cancer diagnosis. The reported negative predictive value (NPV) of mpMRI is used by some clinicians to aid decision making about whether or not to proceed to biopsy. Our contemporary systematic review update of the NPV of mpMRI for clinically significant prostate cancer reflects the latest literature on optimal mpMRI techniques and scoring systems, and aims to provide the latest NPV of mpMRI in this setting.
Methods: We conducted a systematic literature search and included studies from 2016-2018 which assessed the NPV of mpMRI for clinically significant prostate cancer, using biopsy or clinical follow-up as the reference standard. To ensure that studies included in this analysis reflect contemporary practice, we only included studies in which mpMRIs were interpreted according to the PIRADS or similar institutional Likert grading system. We define a negative mpMRI as either (1) PIRADS/Likert 1-2 or (2) PIRADS/Likert 1-3. Clinically significant prostate cancer (csPCa) was defined as either (1) Gleason grade group â‰¥2 or (2) Gleason grade group â‰¥3. We calculated NPV separately for each combination of negative mpMRI and csPCa. The protocol was registered a priori in PROSPERO [CRD42018111619].
Results: A total of 24 studies with 3,903 patients met our inclusion criteria and were included for analysis. 11 studies (45.8%) included only biopsy naÃ¯ve patients, and a further 9 studies (37.5%) included a mixed population of both biopsy-naÃ¯ve and previous negative biopsy patients. 13 studies (54.2%) performed mpMRI using a 3T scanner, and 5 (20.8%) used both 1.5T and 3T. The majority of studies (70.8%) interpreted their mpMRI according to PIRADS. Studies were assessed for bias as low to moderate. _x000D_
Using definition (1) for a negative mpMRI (PIRADS/Likert 1-2) and clinically significant cancer (Gleason grade group â‰¥2), the pooled NPV was 91.7% [95%CI 88.7-94.3%]. When defining csPCa using definition (2) (Gleason grade group â‰¥3), the NPV for csPCa was 96.7% [95%CI 94.6-98.3%]. _x000D_
Four studies allowed calculation of the pooled NPV using definition (2) for negative mpMRI (PIRADS/Likert 1-3) and definition (1) for clinically significant disease: 85.0% [95%CI 77.8-91%]. Using definition (2) for both negative mpMRI and clinically significant disease, the pooled NPV from two studies was 95.1% [95%CI 92.7-97.0%].
Conclusions: These NPV figures should aid decision making regarding whether to proceed to biopsy in men with an elevated age-specific PSA and an mpMRI reported as PIRADS/Likert 1-2 or 1-3. Additional risk stratification tools can be used to minimise the risk of missing clinically significant disease.