Prediction of clinically significant prostate cancer using multi parametric MRI, biparametric MRI and clinical parameters.

Multiparametric MRI (mpMRI) is gold standard for the primary diagnostic work-up of clinically significant prostate cancer (csPCa). The aim of this study was to assess the benefit of the perfusion sequence and the non-inferiority of an MRI without contrast administration (bpMRI) compared to mpMRI while taking clinical parameters into account. In this retrospective, non-interventional study we examined MRI data from 355 biopsy-naïve patients, performed on a 3T MRI system, evaluated by a board-certified radiologist with over 10 years of experience with subsequent mpMRI-TRUS fusion biopsy. Only 16/355 (4.5%) patients benefited from DCE. In only 3/355 (0.8 %) patients csPCa would have been missed in bpMRI. BpMRI provided sensitivity and specificity (81.4 %; 79.4 %) comparable to mpMRI (75.2 %; 81.8 %). Additionally, bpMRI and mpMRI were independent predictors for the presence of csPCa, individually (OR 15.36; p < 0.001 vs. 12.15; p = 0.006) and after accounting for established influencing factors (OR 12.81; p < 0.001 vs. 6.50; p = 0.012). I When clinical parameters were considered, a more balanced diagnostic performance between sensitivity and specificity was found for mpMRI and bpMRI. Overall, PSA density showed the highest diagnostic performance (AUC = 0,81) for the detection of csPCa. The premise of the study was confirmed. Therefore bpMRI should be adopted as soon as existing limitations have been lifted by prospective multi-reader studies.

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