EFFICACY OF MULTIPARAMETRIC MRI TO INCREASE DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER IN COMPARISON WITH TRU

ABSTRACT Background: Although prostate cancer is a very common cancer in men around the world, its cause is still not well known with multi-factor playing role, on the other hand, screening for the disease is still a matter of debate till now and the controversy about the current diagnostic methods which lead to overdiagnosis and overtreatment with the accompanying side effects and complications which could occur with the prostate biopsy and the treatment for the disease and minimal role of imaging in the diagnosis of prostate cancer encouraged the acceptance of multiparametric MRI (mpMRI) as the suitable tool to detect clinically significant prostate cancer. Objectives: To evaluate the efficacy of multiparametric MRI for the detection of clinically significant prostate cancer compared to transrectal ultrasound. Material and Methods: A cross-sectional comparative study, thirty-seven patients fulfilled our criteria with high PSA(4-15ng/ml), abnormal digital rectal examination, and no previous prostate biopsy or prostatic surgeries were included in our study at Azadi teaching hospital and Vajeen private hospital at Duhok city from March 2020 to December 2021, in which all patients underwent mpMRI and TRUS after taking informed consent from all patients Results: The mean age of our patients was 66.35±7.57(54-81years), and the mean PSA was 6.8470±1.73278(410ng/ml).Our study revealed a significant correlation for both mpMRI and TRUS, with p-value (<0.001) and (0.003) for detection of prostate cancer and clinically significant prostate cancer respectively by TRUS, while the p-value was (0.003) and (<0.001) for the detection of prostate cancer and clinically significant prostate cancer respectively by mpMRI. mpMRI showed sensitivity (75%) and (92.3%) for prostate cancer in general and clinically significant prostate cancer respectively and the specificity for mpMRI was (76.5%) and (70.8%) for prostate cancer and clinically significant prostate cancer respectively, while TRUS showed low sensitivity (30%) and (38.5%) and low specificity (11.8%) and (33.3%) for prostate cancer in general and clinically significant prostate cancer respectively. mpMRI revealed negative predictive value (NPV) (72.2%) and (94.4%) and positive predictive value (PPV) (78.9%) and (63.2%) for prostate cancer in general and clinically significant prostate cancer respectively. While TRUS revealed negative predictive value (NPV) (12.5%) and (50%) and positive predictive value (PPV) (28.6%) and (23.8%) for prostate cancer in general and clinically significant prostate cancer respectively. Conclusion: Multiparametric MRI showed high sensitivity, specificity, NPV, and PPV compared to transrectal ultrasound in detecting clinically significant prostate cancer. Therefore, it can be used to avoid unnecessary prostate biopsies in the future.