Value of Magnetic Resonance Spectroscopy Imaging and Dynamic Contrast-Enhanced Imaging for Detecting Prostate Cancer Foci in Men With Prior Negative Biopsy
in: Clinical Cancer Research, Alessandro Sciarra, Valeria Panebianco, Mauro Ciccariello 2010.
Purpose: This study aimed to prospectively analyze the role of magnetic resonance spectroscopy
imaging (MRSI) and dynamic-contrast enhancement magnetic resonance (DCEMR) in the detection
of prostate tumor foci in patients with persistently elevated prostate-specific antigen levels (in the
range of 4 ng/mL to <10 ng/mL) and prior negative random trans-rectal ultrasound (TRUS)-guided
Experimental Design: This was a prospective randomized single-center study. One hundred and
eighty eligible cases were included in the study. Patients in group A were submitted to a second random prostate biopsy, whereas patients in group B were submitted to a 1H-MRSI-DCEMR examination and
samples targeted on suspicious areas were associated to the random biopsy.
Results: At the second biopsy, a prostate adenocarcinoma histologic diagnosis was found in 22 of 90
cases (24.4%) in group A and in 41 of 90 cases (45.5%) in group B (P = 0.01). On a patient-by-patient
basis, MRSI had 92.3% sensitivity, 88.2% specificity, 85.7% positive predictive value (PPV), 93.7%
negative predictive value (NPV), and 90% accuracy; DCEMR had 84.6 % sensitivity, 82.3% specificity,78.5% PPV, 87.5% NPV, and 83.3% accuracy; and the association MRSI plus DCEMR had 92.6%
sensitivity, 88.8% specificity, 88.7% PPV, 92.7% NPV, and 90.7% accuracy, for predicting prostate
Conclusions: The combination of MRSI and DCEMR showed the potential to guide biopsy to cancer
foci in patients with previously negative TRUS biopsy. To avoid a potential bias, represented from having taken more samples in group B (mean of cores, 12.17) than in group A (10 cores), in the future a MRSI/DCEMR directed biopsy could be prospectively compared with a saturation biopsy procedure.