Insights into imaging · 2026
Diagnostic value of prostate magnetic resonance imaging in men with prostate-specific antigen levels ≥ 15 ng/mL for biopsy decision-making.
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Trappe Samuel, Schimmöller Lars, Althoff Patrick, Schero Karla Johanna, Berg Sebastian, Radtke Jan Philipp, Esposito Irene, Roghmann Florian, Albers Peter, Antoch Gerald, Al-Monajjed Rouvier, Boschheidgen Matthias
Аннотация
OBJECTIVES: To determine the value of MRI in men with highly elevated PSA values for the exclusion of clinically significant prostate cancer (csPC).
MATERIALS AND METHODS: In this retrospective bicenter cohort study, consecutive men with PSA values ≥ 15 ng/mL and multiparametric (mp) MRI were included. We excluded patients with acute prostatitis and patients without histopathology or follow-up. Examinations were evaluated regarding MRI quality, PSAD, and PI-RADS classification. For all patients with subsequent biopsy, PC and csPC detection rates were determined. In a subgroup analysis, patients with and without the presence of csPC were compared regarding clinical and MRI parameters.
RESULTS: Finally, 376 patients (median PSA 20 ng/mL) were included. MRI quality was excellent (median PI-QUAL 3). 26% of the patients revealed an MRI with a PI-RADS category 2, 16% were classified as category 3, 12% PI-RADS 4, and 46% showed a PI-RADS 5. A total of 280 patients underwent systematic screening with or without targeted prostate biopsy. Among these, 42% with PSA values ranging from 15 to 116 ng/mL (median 19.5 ng/mL) showed no presence of PC. Overall, csPC detection rates were 94% for PI-RADS 5 and 51% for PI-RADS 4. No csPC were identified in PI-RADS 2, and 8% in PI-RADS 3. Comparative analysis between patients with and without csPC revealed significant differences in age, PSA, PSAD, and PI-RADS (p ≤ 0.05).
CONCLUSIONS: mpMRI demonstrated excellent performance in the detection of csPC in this high-risk cohort with PSA levels ≥ 15 ng/mL. High-quality MRI helps to exclude csPC in cases with significantly elevated PSA levels to avoid unnecessary prostate biopsies. CRITICAL RELEVANCE STATEMENT: mpMRI demonstrated a high diagnostic accuracy for csPCs in men with PSA ≥ 15 ng/mL, and in cases of non-suspicious MRI findings, it can avoid unnecessary biopsies in these patients at risk.
KEY POINTS: MpMRI demonstrated high diagnostic accuracy in men with PSA values of ≥ 15 ng/mL. MpMRI enables the reliable exclusion of csPC in cases with non-suspicious MRI findings in these patients. In patients with significantly elevated PSA levels, mpMRI provides an effective risk stratification to avoid unnecessary biopsies.
MATERIALS AND METHODS: In this retrospective bicenter cohort study, consecutive men with PSA values ≥ 15 ng/mL and multiparametric (mp) MRI were included. We excluded patients with acute prostatitis and patients without histopathology or follow-up. Examinations were evaluated regarding MRI quality, PSAD, and PI-RADS classification. For all patients with subsequent biopsy, PC and csPC detection rates were determined. In a subgroup analysis, patients with and without the presence of csPC were compared regarding clinical and MRI parameters.
RESULTS: Finally, 376 patients (median PSA 20 ng/mL) were included. MRI quality was excellent (median PI-QUAL 3). 26% of the patients revealed an MRI with a PI-RADS category 2, 16% were classified as category 3, 12% PI-RADS 4, and 46% showed a PI-RADS 5. A total of 280 patients underwent systematic screening with or without targeted prostate biopsy. Among these, 42% with PSA values ranging from 15 to 116 ng/mL (median 19.5 ng/mL) showed no presence of PC. Overall, csPC detection rates were 94% for PI-RADS 5 and 51% for PI-RADS 4. No csPC were identified in PI-RADS 2, and 8% in PI-RADS 3. Comparative analysis between patients with and without csPC revealed significant differences in age, PSA, PSAD, and PI-RADS (p ≤ 0.05).
CONCLUSIONS: mpMRI demonstrated excellent performance in the detection of csPC in this high-risk cohort with PSA levels ≥ 15 ng/mL. High-quality MRI helps to exclude csPC in cases with significantly elevated PSA levels to avoid unnecessary prostate biopsies. CRITICAL RELEVANCE STATEMENT: mpMRI demonstrated a high diagnostic accuracy for csPCs in men with PSA ≥ 15 ng/mL, and in cases of non-suspicious MRI findings, it can avoid unnecessary biopsies in these patients at risk.
KEY POINTS: MpMRI demonstrated high diagnostic accuracy in men with PSA values of ≥ 15 ng/mL. MpMRI enables the reliable exclusion of csPC in cases with non-suspicious MRI findings in these patients. In patients with significantly elevated PSA levels, mpMRI provides an effective risk stratification to avoid unnecessary biopsies.