Usefulness of urinary biomarker-based risk score and multiparametric MRI for clinically significant prostate cancer detection in biopsy-naïve patients

Abstract

Introduction & Objectives: Magnetic resonance imaging (MRI), genetic urinary test (GUT), and prostate cancer prevention trial risk calculator version 2.0 (PCPTRC2) may help decide the need for an invasive procedure in biopsy-naïve patients. This study aimed to investigate the accuracy of different techniques (MRI, GUT, PCPTRC2) for the clinically significant prostate cancer (csPCa) diagnostic. Materials & Methods: 208 patients were included prospectively. All subjects underwent prostate mpMRI, GUT and ultrasound (US) guided biopsy. The csPCa risk was calculated using PCPTRC2. Post digital rectal examination (DRE) GUT was performed measuring RNA levels of PCA3 and T:E fusion genes. Results: A positive GUT score was found in 67.8% and PIRADS 3 and more in 81.7% of all cases. The combination of GUT with mpMRI showed significantly higher sensitivity (99.1%) than GUT and mpMRI alone, 84.4% and 93.8%, respectively (p ≤ 0.05). Similarly, very high sensitivity (99,0%) was achieved by combining mpMRI with PCPTCR2. Nevertheless, mpMRI plus GUT combination exceeded mpMRI plus PCPTCR2 by allowing to save a higher fraction of unnecessary biopsies, 25% and 2,4%, respectively. Conclusions: GUT and mpMRI combination would allow saving a substantial fraction of unnecessary biopsies with minimal risk of missing csPCa cases.