Multiparametric magnetic resonance imaging and follow-up to avoid prostate biopsy in 4259 men

Objective To determine the proportion of men avoiding biopsy because of negative multiparametric magnetic resonance imaging (mpMRI) findings in a prostate MRI expert centre, and to assess the number of clinically significant prostate cancers (csPCa) detected during follow-up. Patients and methods Retrospective study of 4259 consecutive men having mpMRI of the prostate between January 2012 and December 2017, with either a history of previous negative transrectal ultrasonography-guided biopsy or biopsy naive. Patients underwent mpMRI in a referral centre. Lesions were classified according to Prostate Imaging Reporting And Data System (PI-RADS) versions 1 and 2. Negative mpMRI was defined as an index lesion PI-RADS <= 2. Follow-up until 13 October 2018 was collected by searching the Dutch Pathology Registry (PALGA). Gleason score >= 3 + 4 was considered csPCa. Kaplan-Meier analysis and univariable logistic regression models were used in the cohort of patients with negative mpMRI and follow-up. Results Overall, in 53.6% (2281/4259) of patients had a lesion classified as PI-RADS <= 2. In 320 patients with PI-RADS 1 or 2, follow-up mpMRI was obtained after a median (interquartile range) of 57 (41-63) months. In those patients, csPCa diagnosis-free survival (DFS) was 99.6% after 3 years. Univariable logistic regression analysis revealed age as a predictor for csPCa during follow-up (P < 0.05). In biopsied patients, csPCa was detected in 15.8% (19/120), 43.2% (228/528) and 74.5% (483/648) with PI-RADS 3, 4 and 5, respectively. Conclusion More than half of patients having mpMRI of the prostate avoided biopsy. In those patients, csPCa DFS was 99.6% after 3 years.