Intermediate-term oncological outcomes after a negative endorectal coil multiparametric MRI of the prostate in patients without biopsy proven prostate cancer

Published:September 25, 2022DOI:


      • Omitting prostate biopsy after a negative multiparametric MRI is controversial, since significant cancer may be missed.
      • Only 10% of our patients with a negative MRI and without known prostate cancer were later diagnosed with significant disease.
      • Patients developing significant disease had higher PSA velocity, suggesting PSA monitoring may be an alternative to biopsy.



      Investigate the intermediate-term oncological outcome after negative multiparametric MRI (mpMRI) of the prostate in patients without biopsy proven prostate cancer (PCa).


      The retrospective study included 121 patients with negative mpMRI (Prostate Imaging Reporting and Data System version 2.1 category<3) performed at our institution between 2012 and 2017 without known biopsy proven PCa. Clinical and pathological data were collated including post-MRI prostatic tissue diagnoses with highest Grade Group and most recent prostate specific antigen (PSA) levels up to any definitive prostate cancer treatment. Mean PSA velocities between patients with and without a subsequent diagnosis of Grade Group 2 or higher (GG2+) PCa were compared, and an optimal threshold value was calculated.


      Outcome data available included PSA values in 117 patients and prostate tissue sampling in 52 patients. Over a median follow up interval of 49.8 months, only 11 of 121 patients (9.1%) were diagnosed with GG2+ PCa, 10 patients (8.3%) with GG1 PCa, and 31 patients (25.6%) had negative prostate tissue samples. Mean PSA velocity was significantly higher in the patients diagnosed with GG2+ PCa (3.87 ng/mL/year) compared to those not diagnosed with GG2+ PCa (−0.71 ng/mL/year, p < 0.001). A threshold PSA velocity of 0.27 ng/mL/year had a 100% sensitivity and 69.8% specificity for GG2+ PCa (AUC: 0.898).


      <10% of patients with negative mpMRI without prior biopsy proven PCa were diagnosed with GG2+ PCa over median follow up of over four years and were associated with PSA velocity of ≥0.27 ng/mL/year. PSA monitoring may be a reasonable management strategy in patients with a negative mpMRI without biopsy proven PCa.


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        • Siegel R.L.
        • et al.
        Cancer statistics, 2021.
        CA Cancer J Clin. 2021; 71: 7-33
        • Negoita S.
        • et al.
        Annual report to the nation on the status of cancer, part II: recent changes in prostate cancer trends and disease characteristics.
        Cancer. 2018; 124: 2801-2814
        • Turkbey B.
        • et al.
        Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2.
        Eur Urol. 2019; 76: 340-351
        • Moldovan P.C.
        • et al.
        What is the negative predictive value of multiparametric magnetic resonance imaging in excluding prostate cancer at biopsy? A systematic review and meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel.
        Eur Urol. 2017; 72: 250-266
        • Borghesi M.
        • et al.
        Complications after systematic, random, and image-guided prostate biopsy.
        Eur Urol. 2017; 71: 353-365
        • An J.Y.
        • et al.
        Ruling out clinically significant prostate cancer with negative multi-parametric MRI.
        Int Urol Nephrol. 2018; 50: 7-12
        • Norris J.M.
        • et al.
        What type of prostate cancer is systematically overlooked by multiparametric magnetic resonance imaging? An analysis from the PROMIS cohort.
        Eur Urol. 2020; 78: 163-170
        • Rouvière O.
        • et al.
        Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study.
        Lancet Oncol. 2019; 20: 100-109
        • Drost F.H.
        • et al.
        Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer.
        Cochrane Database Syst Rev. 2019; 4 (p. CD012663)
        • Ahmed H.U.
        • et al.
        Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study.
        Lancet. 2017; 389: 815-822
        • Parker C.
        • et al.
        Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2020; 31: 1119-1134
      1. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Prostate Cancer Version 2.2021.
        • Wagaskar V.G.
        • et al.
        Clinical utility of negative multiparametric magnetic resonance imaging in the diagnosis of prostate cancer and clinically significant prostate cancer.
        Eur Urol Open Sci. 2021; 28: 9-16
        • Falagario U.G.
        • et al.
        Avoiding unnecessary magnetic resonance imaging (MRI) and biopsies: negative and positive predictive value of MRI according to prostate-specific antigen density, 4Kscore and risk calculators.
        Eur Urol Oncol. 2020; 3: 700-704
        • Liang L.
        • et al.
        Analysis of risk factors for determining the need for prostate biopsy in patients with negative MRI.
        Sci Rep. 2021; 11: 6048
        • Panebianco V.
        • et al.
        Negative multiparametric magnetic resonance imaging for prostate cancer: what's Next?.
        Eur Urol. 2018; 74: 48-54
        • Venderink W.
        • et al.
        Multiparametric magnetic resonance imaging and follow-up to avoid prostate biopsy in 4259 men.
        BJU Int. 2019; 124: 775-784
        • Barrett T.
        • et al.
        PI-RADS version 2.1: one small step for prostate MRI.
        Clin Radiol. 2019; 74: 841-852
        • Bezinque A.
        • et al.
        Determination of prostate volume: a comparison of contemporary methods.
        Acad Radiol. 2018; 25: 1582-1587
        • Itatani R.
        • et al.
        Negative predictive value of multiparametric MRI for prostate cancer detection: outcome of 5-year follow-up in men with negative findings on initial MRI studies.
        Eur J Radiol. 2014; 83: 1740-1745
        • Buisset J.
        • et al.
        Negative prebiopsy magnetic resonance imaging and risk of significant prostate cancer: baseline and long-term followup results.
        J Urol. 2021; 205: 725-731
        • Wang R.S.
        • et al.
        Determination of the role of negative magnetic resonance imaging of the prostate in clinical practice: is biopsy still necessary?.
        Urology. 2017; 102: 190-197
        • Ullrich T.
        • et al.
        Quality comparison of 3 tesla multiparametric MRI of the prostate using a flexible surface receiver coil versus conventional surface coil plus endorectal coil setup.
        Abdominal Radiol. 2020; 45: 4260-4270
        • Turkbey B.
        • et al.
        Comparison of endorectal coil and nonendorectal coil T2W and diffusion-weighted MRI at 3 tesla for localizing prostate cancer: correlation with whole-mount histopathology.
        J Magn Reson Imaging. 2014; 39: 1443-1448
        • Futterer J.J.
        • et al.
        Prostate cancer: comparison of local staging accuracy of pelvic phased-array coil alone versus integrated endorectal-pelvic phased-array coils. Local staging accuracy of prostate cancer using endorectal coil MR imaging.
        Eur Radiol. 2007; 17: 1055-1065
        • Dhatt R.
        • et al.
        MRI of the prostate with and without endorectal coil at 3 T: correlation with whole-mount histopathologic Gleason score.
        AJR Am J Roentgenol. 2020; 215: 133-141