Rebiopsy for Prostate Cancer: Can Some Men With Negative MRI Avoid It?
Posted: Monday, October 8, 2018
Andre Luis de Castro Abreu, MD, of the USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, and colleagues suggest that a subset of men with negative magnetic resonance imaging (MRI) may be able to safely avoid rebiopsy. These men, who have a favorable prostate-specific antigen (PSA) density and prior negative biopsy, may be able to avoid biopsy-related morbidity and overdiagnosis of prostate cancer, the investigators indicated. These prospective cohort findings were published in The Journal of Urology.
“Conversely, prostate biopsy should be considered in biopsy-naïve men, regardless of negative [multiparametric] MRI, particularly those with a PSA density of greater than 0.15 ng/mL/cc,” the investigators noted.
A total of 1,149 consecutive men undergoing prostate biopsy (from October 2011 to March 2017) were the focus of this single-institution study, with 135 having a prebiopsy negative multiparametric MRI. The investigators used PSA density and prior biopsy history to evaluate the detection of clinically significant prostate cancer.
Among all the men with negative MRI, 18% were found to have clinically significant prostate cancer. When combined with a PSA density of less than 0.15 ng/mL/cc and a history of prior negative prostate biopsy, the negative predictive value for a negative MRI was 100%. Independent predictors of the absence of clinically significant prostate cancer included smaller prostates, higher PSA density, and no history of prior negative biopsy.