MPMRI PREDICTIVE VALUE IN THE DIFFERENT PROSTATE AREAS IN DETECTING PROSTATE CANCER

Background/Aim: The aim of this study was to determine the predictive value of suspicious areas at multiparametric magnetic resonance imaging (mpMRI) considering the different prostatic regions. Materials and Methods: Between May 2015 and March 2017 110 patients were analyzed. Of these patients, 58 were naïve of a prostate biopsy, 26 were undergoing a first negative prostate biopsy, but have a persistent suspicious of prostate cancer (PCa), 9 had a history of PIN or ASAP, 17 were in active surveillance. The mpMRIs were performed in different centers. Twenty-seven quadruple prostate maps were used to locate the neoplasms. Five macroareas were considered: Apex, mid, base, transitional zone (1a, 3a, 5a, 7a, 9a, 11a) and anterior zone (2a, 4a, 6a, 8a, 10a, 12a, 13as, 14as, 15as). For each suspicious area a PIRADSv2 value was assessed. We made fusion “cognitive” biopsy on each patient in a single center. In case of negative mpMRI a prostate mapping was performed. Results: Mean age of the patients was 63.91 years, mean prostate volume was 46.75 ml, and mean number of specimens was 14.74. In 10 cases the mpMRI was not used. A total of 128 suspected lesions was found in Base areas: 32, Medium: 36, Apex: 19, Transition: 35, Anterior: 6. From the analysis of results, the following zonal features emerged: Anterior (Specificity: 98.9%; Sensitivity: 83.3%; PPV: 83.3%; NPV: 99%; Accuracy: 98%); Apex (Specificity: 89.5%; Sensitivity: 47.8%; PPV: 57.9%; NPV: 85%; Accuracy: 80%); Mid (Specificity: 71.4%; Sensitivity: 63.7%; PPV: 38.8%; NPV: 87.3%; Accuracy: 70%); Base (Specificity: 70%; Sensitivity: 42.1%; PPV: 25%; NPV: 83.6%; Accuracy: 64.5%); Transition (Specificity: 68.2%; Sensitivity: 63.6%; PPV: 20%; NPV: 93.8%; Accuracy: 67.7%). There was no correlation between the Gleason score and the PIRADS found in mpRMI in the same region. In total, 33 PIRADS 3 sites were evaluated and 11 areas (33%) were positive for prostate cancer (GG1: 5, GG2: 3, GG3: 1, GG4: 2). In the other cases, however, the areas classified with PIRADS 3 showed a negative tumor response, creating doubts regarding the real utility of classifying suspected lesions with this statement. Conclusion: The predictive value of mpRMI changes according to the prostate region was examined. The transition zone was burdened by a large number of false positives, but by a fairly negative predictive value. The front and apical regions had an excellent positive predictive value and discrete negative predictive value. Th