Endorectal Magnetic Resonance Imaging and Spectroscopy Are Useful for Selecting Candidates for Biopsy among Patients with Persistently Elevated Prostate Specific Antigen

Josep Comet-Batlle, Carles Barceló-Vidal, Joan Carles Vilanova-Busquets, Roger Boix-Orri, Albert Maroto-Genover, Joan Areal-Calama, Margarita Osorio-Fernandez, Ferran Perez-Bueno, Nuria Fuertes-Izquierdo

Department of Computer Science and Applied Mathematics, University of Girona, Catalonia, Spain.
Pathology Department, Hospital Dr. Josep Trueta, Catalonia, Spain.
Radiology Department, Hospital Dr. Josep Trueta, Catalonia, Spain.
Ressonància Girona, Catalonia, Spain.
Urology Department, Hospital Dr. Josep Trueta, Catalonia, Spain.
Urology Department, Hospital Trias Pujol, Catalonia, Spain.

DOI: 10.4236/oju.2012.223035                

Abstract

Objective: To evaluate the efficacy of endorectal Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spetroscopic Imaging (MRSI) combined with total prostate-specific antigen (tPSA) and free prostate-specific antigen (fPSA) in selecting candidates for biopsy. Subjects and Methods: 246 patients with elevated tPSA (median: 7.81 ng/ml) underwent endorectal MRI and MRSI before Transrectal Ultrasound (TRUS) biopsy (10 peripheral + 2 central cores); patients with positive biopsies were treated with radical intention; those with negative biopsies were followed up and underwent MRSI before each additional biopsy if tPSA rose persistently. Mean follow-up: 27.6 months. We compared MRI, MRSI, tPSA, and fPSA with histopathology by sextant and determined the association between the Gleason score and MRI and MRSI. We determined the most accurate combination to detect prostate cancer (PCa) using receiver operating curves; we estimated the odds ratios (OR) and calculated sensitivity, specificity, and positive and negative predictive values. Results: No difference in tPSA was found between patients with and without PCa (p = 0.551). In the peripheral zone, the risk of PCa increased with MRSI grade; patients with high-grade MRSI had the greatest risk of PCa over time (OR = 328.6); the model including MRI, MRSI, tPSA, and fPSA was more accurate (Area under Curve: AUC = 95.7%) than MRI alone (AUC = 85.1%) or fPSA alone (AUC = 78.1%), but not than MRSI alone (94.5%). In the transitional zone, the model was less accurate (AUC = 84.4%). The association (p = 0.005) between MRSI and Gleason score was significant in both zones. Conclusions: MRSI is useful in patients with elevated tPSA. High-grade MRSI lesions call for repeated biopsies. Men with negative MRSI may forgo further biopsies because a significantly high Gleason lesion is very unlikely.

Keywords

Endorectal MRI; Spectroscopy; Prostate Cancer; Diagnosis; Prostate Specific Antigen (PSA); Free to Total PSA Ratio (F/T PSA)

Conflicts of Interest

The authors declare no conflicts of interest.

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