Geert M. Villeirs MD, PhD, Presenter: Nothing to Disclose

Pieter J De Visschere MD, Abstract Co-Author: Nothing to Disclose

Gert De Meerleer MD, PhD, Abstract Co-Author: Nothing to Disclose

Willem Oosterlinck MD, PhD, Abstract Co-Author: Nothing to Disclose

To assess the value of morphologic fast T2-weighted MR imaging with spectroscopic imaging (MRI+MRSI) in the exclusion of high grade prostate carcinoma (Gleason 4+3 or higher) in patients with elevated PSA.

Three hundred and fifty six men (mean PSA 11.5 ng/mL, range 0.4-133.0 ng/mL) were examined with MRI+MRSI. Prostate cancer was histopathologically proven in 220 patients and non-evidence of cancer was determined after at least 1 year clinical follow-up in 136 subjects, of whom 126 had a normal MRI+MRSI. One hundred and nineteen of them (mean PSA 7.8 ng/mL, range 2.8-22.0 ng/mL) were further followed-up for at least 2 years (mean 3.1 years, range 2-7 years) with regular PSA measurements. Patients with rising PSA were further assessed by the referring urologist and transrectal biopsies were obtained.

In the overall group (n=356), the sensitivity of MRI+MRSI for high grade tumors was 92.7% (38/41) and the negative predictive value of a normal MRI+MRSI for excluding a high grade tumor was 98.4% (184/187). In the follow-up group with normal MRI+MRSI (n=119), PSA remained stable in 26 men (22%) and decreased in 52 men (44%). In 41 men (34%) with rising PSA, transrectal biopsies detected 8 prostate cancers (4 pT2a, 1 pT2b and 3 pT2c; 4 Gleason score 3+3, 2 score 3+4, 1 score 4+3 and 1 score 4+5) after 2.5-6.0 years of follow-up. The single high-grade tumor focus (Gleason 4+5) was detected in only one out of 30 biopsy cores.

After a normal MRI+MRSI, two-thirds of patients with elevated PSA showed stabilization or decrease of PSA-levels and no clinically significant high grade prostate cancers were detected. This is of particular importance in the choice for active surveillance, or to reduce the need for rebiopsies in patients with repetitively negative transrectal biopsies.

Magnetic resonance imaging and spectroscopic imaging is able to reliably exclude clinically significant high grade prostate cancer in patients with elevated PSA.

Villeirs, G, De Visschere, P, De Meerleer, G, Oosterlinck, W, Combined Magnetic Resonance Imaging and Spectroscopy in the Exclusion of High Grade Prostate Carcinoma in Patients with Elevated PSA.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9014775.html