Multiparametric MRI for prostate cancer detection: Performance in patients with prostate-specific antigen values between 2.5 and 10 ng/mL

Purpose To assess the diagnostic performance of multiparametric MRI (mpMRI), in the detection of prostate cancer, including morphologic sequences (mMRI), diffusion-weighted imaging (DWI), and MR spectroscopy (MRS). Combined morphological and functional MRI scoring systems was used for urological–radiological work-up of patients with a prostate-specific antigen (PSA) value ≤ 10 ng/mL. Materials and Methods The study included 136 of 200 consecutive patients with PSA values between 2.5 and 4 ng/mL and an abnormal digital rectal examination (DRE), or patients with PSA values between 4 and 10 ng/mL, independently from DRE. Each patient provided informed consent to undergo at serum free/total PSA ratio (f/t PSA) assay, mMRI, MRS, DWI, and transrectal ultrasonography (TRUS) biopsy. The MRI datasets were scored singularly; then mMRI and DWI, mMRI and MRS data were combined in a coupled score, and finally mMRI, DWI, and MRS data were combined in a single score (cMRI score). Results Scores were correlated to negative biopsies and significant/insignificant Gleason score biopsies. Receiver-operator-characteristic curve and McNemar tests were performed. Cancer was diagnosed in 18% of patients. The cMRI score showed: (i) the highest sensitivity (0.84) and negative predictive value (0.93); (ii) a significant correlation with Gleason score; and (iii) a statistically different median value between significant and insignificant Gleason score. Conclusion The cMRI score could identify patients with a PSA≤10 ng/mL who will have a negative work-up, for its high negative predictive value, and patients at high risk for significant prostate cancer because of its correlation with the Gleason score.