Diagnostic Place Value of the multiparametric MRI with targeted Fusion Biopsy of the Prostate in Patients with PSA Increase and negative Stamping Biopsy for the Detection of clinically significant Prostate Carcinomas Correlation with the Gleason Score

Aims: To increase diagnostic precision and to reduce overtreatment of low-risk malignant disease, multiparametric MRI (mpMRl) combined with ultrasound (US) fusion guided biopsy of the prostate were performed. Methods: In 99 male patients with increased PSA plasma levels and previous negative standard biopsy procedures, mpMRl was carried out followed by US fusion guided perinea! biopsy. PI-RADS-Data (PS) of mpMRI and histopathological Gleason score (GS) were categorized and statistically compared. Results: Lesions in 72/99 (73 %) of patients were determined to be suspect of malignancy, based on a PS 4 or 5. In 33/99 (33 %) of patients, malignancy could not be confirmed by histopathology. With regard to the remaining 66 patients with previous negative biopsy results, 42 (64%) were diagnosed with a low-grade carcinoma (GS 6, 7a) and 24 (36 %) with a high-grade carcinoma (GS >= 7b). The proportion of corresponding results in mpMRI (PS 4-5) when a high-grade carcinoma had been detected, was 21/24 (88%), which related to a sensitivity of 88% and a negative predictive value (NPV) of 85% (p=0,002). In addition, 35 of 42 patients (83%), graded PS 4-5 in mpMRI, were diagnosed with low-grade carcinoma-positive (p <0,001). Sensitivity to differentiation between low- and high-grade carcinomas (GS <= 7a vs. >= 7b) by means of PS was 88% with a NPV of 70% (p =0,74). Conclusion: Our results suggest that mpMRl combined with US-fusion guided biopsy is able to detect considerably higher rates of clinically relevant prostate malignancies compared to conventional diagnostic procedures. However, no statistical significance could be shown regarding the differentiation between high- and low-grade carcinomas. It is hoped that the hybrid methods PSMA-PET/CT or PSMA-PET/MRI will lead to the next optimization step in the differentiation between high- and low-grade carcinomas which so far has been unsatisfactory.