Multiparametric MRI Lesion Classified as Prostate Imaging-Reporting and Data System 5 but Histopathologically Described as Benign: A Case Report and Review of Literature

Introduction: Prostate cancer (PCa) is the most common malignancy in men. The multiparametric MRI (mpMRI) significantly improved the diagnostic approach of PCa. Although PCa is highly likely to be present in prostate imaging-reporting and data system (PI-RADS) 5 lesions, there are up to 18% of PI-RADS 5 lesions with benign histopathology after targeted biopsy. Case Description: We present the case of a 66-year-old man who was referred to our hospital for MRI/ultrasound fusion-based targeted biopsy due to an elevated PSA and a PI-RADS 5 lesion described in the mpMRI. After 2 consecutive biopsies, the mpMRI target showed no malignancy. The lesion was described as PI-RADS 2 two years later. Conclusion: This case demonstrates the risk of false-positive classified PI-RADS 5 lesions in the mpMRI and the challenge in some cases to distinguish between BPH nodules and cancer. Until today, a limited amount of studies exists concerning this issue. However, further studies are required to evaluate further characteristics associated with a higher possibility of histopathologically benign findings in PI-RADS 5 lesions.

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Evaluating the efficacy of a low-cost, minimally-invasive cognitive MRI targeted biopsy protocol in the Prostate Imaging Reporting and Data System (PI-RADS) version 2 era.

10.21203/rs.2.19771/v1 ◽

2019 ◽

Author(s):

Yuta Takeshima ◽

Yoshinori Tanaka ◽

Kotaro Takemura ◽

Shusaku Nakazono ◽

Eiko Yamashita ◽

...

Keyword(s):

Prostate Cancer ◽

Diagnostic Performance ◽

Low Cost ◽

Multiparametric Mri ◽

Data System ◽

Targeted Biopsy ◽

Prostate Imaging ◽

Biopsy Protocol ◽

Clinically Significant ◽

Systematic Biopsy

Abstract Background: New MRI-guided targeting biopsy methods have increased cancer yield of prostate biopsies. However, cost and time constraints have made it difficult for many institutions to implement these newer methods. We evaluated the diagnostic performance of a low-cost, minimally-invasive, cognitive MRI-targeted biopsy protocol based on 1.5T multiparametric MRI graded with Prostate Imaging Reporting and Data System version 2 that is easily implemented in any low- to intermediate- volume center. Methods: Retrospective analysis of 255 patients who underwent prostate biopsy between December 2016 and March 2019 at a single facility. Indication for biopsy was based on clinical parameters including 1.5T multiparametric MRI. In addition to 10-core systematic biopsy, targeted cores were obtained with cognitive recognition under ultrasound. A control group of 198 patients biopsied without prior MRI from January to December 2015 was also analyzed. Results: Prostate biopsy preceded by MRI had a significantly higher probability of detecting both prostate cancer (68.1% vs. 43.6%) and clinically significant cancer (56.2% vs. 29.4%) (p values< 0.01). Combination of systematic biopsy and targeted biopsy outperformed either regimen alone for detection of prostate cancer. Multivariate analysis showed PSA density and prostate imaging reporting and data system score were independent risk factors of prostate cancer. A proposed diagnostic model showed sensitivity of 88.6%, specificity of 55%, PPV of 81.2%, NPV of 68.8%, and accuracy of 78%. Prostate imaging reporting and data system score was correlated with a higher presence of prostate cancer, clinically significant prostate cancer, and a higher pathological grade. Conclusions: Incorporation of pre-biopsy MRI imaging, scoring, and targeted biopsy improved cancer yield and achieved diagnostic performance comparable to newer methods of higher cost. Future alterations of possible benefit included increasing the number of target cores per lesion, and combining prostate imaging reporting and data system score and PSA density as indicators for biopsy.

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