Abstract
Introduction: Prostate cancer (PCa) is the most common malignancy in men. The multiparametric MRI (mpMRI) significantly improved the diagnostic approach of PCa. Although PCa is highly likely to be present in prostate imaging-reporting and data system (PI-RADS) 5 lesions, there are up to 18% of PI-RADS 5 lesions with benign histopathology after targeted biopsy. Case Description: We present the case of a 66-year-old man who was referred to our hospital for MRI/ultrasound fusion-based targeted biopsy due to an elevated PSA and a PI-RADS 5 lesion described in the mpMRI. After 2 consecutive biopsies, the mpMRI target showed no malignancy. The lesion was described as PI-RADS 2 two years later. Conclusion: This case demonstrates the risk of false-positive classified PI-RADS 5 lesions in the mpMRI and the challenge in some cases to distinguish between BPH nodules and cancer. Until today, a limited amount of studies exists concerning this issue. However, further studies are required to evaluate further characteristics associated with a higher possibility of histopathologically benign findings in PI-RADS 5 lesions.
References
1.
Ferlay
J
, Parkin
DM
, Steliarova-Foucher
E
. Estimates of cancer incidence and mortality in Europe in 2008
. Eur J Cancer
. 2010
;46
(4
):765
–781
. .2.
Heidenreich
A
, Bastian
PJ
, Bellmunt
J
, Bolla
M
, Joniau
S
, van der Kwast
T
. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013
. Eur Urol
. 2014
;65
(1
):124
–37
. .3.
Ahmed
HU
, El-Shater Bosaily
A
, Brown
LC
, Gabe
R
, Kaplan
R
, Parmar
MK
, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study
. Lancet
. 2017
;389
(10071
):815
–22
. .4.
Kasivisvanathan
V
, Rannikko
AS
, Borghi
M
, Panebianco
V
, Mynderse
LA
, Vaarala
MH
, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis
. N Engl J Med
. 2018
;378
(19
):1767
–77
. .5.
Siddiqui
MM
, Rais-Bahrami
S
, Turkbey
B
, George
AK
, Rothwax
J
, Shakir
N
, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer
. JAMA
. 2015
;313
(4
):390
–7
. .6.
Barentsz
JO
, Richenberg
J
, Clements
R
, Choyke
P
, Verma
S
, Villeirs
G
, et al. ESUR prostate MR guidelines 2012
. Eur Radiol
. 2012
;22
(4
):746
–57
. .7.
Weinreb
JC
, Barentsz
JO
, Choyke
PL
, Cornud
F
, Haider
MA
, Macura
KJ
, et al. PI-RADS prostate imaging – reporting and data system: 2015, Version 2
. Eur Urol
. 2016
;69
(1
):16
–40
. .8.
Mehralivand
S
, Bednarova
S
, Shih
JH
, Mertan
FV
, Gaur
S
, Merino
MJ
, et al. Prospective evaluation of PI-RADS version 2 using the international society of urological pathology prostate cancer grade group system
. J Urol
. 2017
;198
(3
):583
–90
. .9.
Tan
N
, Lin
WC
, Khoshnoodi
P
, Asvadi
NH
, Yoshida
J
, Margolis
DJ
, et al. In-bore 3-T MR-guided transrectal targeted prostate biopsy: prostate imaging reporting and data system version 2-based diagnostic performance for detection of prostate cancer
. Radiology
. 2017
;283
(1
):130
–9
. .10.
Sheridan
AD
, Nath
SK
, Aneja
S
, Syed
JS
, Pahade
J
, Mathur
M
, et al. MRI-ultrasound fusion targeted biopsy of prostate imaging reporting and data system version 2 category 5 lesions found false-positive at multiparametric prostate MRI
. AJR Am J Roentgenol
. 2018
;210
(5
):W218
–25
. .11.
Siddiqui
MM
, Rais-Bahrami
S
, Truong
H
, Stamatakis
L
, Vourganti
S
, Nix
J
, et al. Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy
. Eur Urol
. 2013
;64
(5
):713
–9
. .12.
Baco
E
, Rud
E
, Eri
LM
, Moen
G
, Vlatkovic
L
, Svindland
A
, et al. A randomized controlled trial to assess and compare the outcomes of two-core prostate biopsy guided by fused magnetic resonance and transrectal ultrasound images and traditional 12-core systematic biopsy
. Eur Urol
. 2016
;69
(1
):149
–56
. .13.
Wysock
JS
, Rosenkrantz
AB
, Huang
WC
, Stifelman
MD
, Lepor
H
, Deng
FM
, et al. A prospective, blinded comparison of magnetic resonance (MR) imaging-ultrasound fusion and visual estimation in the performance of MR-targeted prostate biopsy: the PROFUS trial
. Eur Urol
. 2014
;66
(2
):343
–51
. .14.
Panebianco
V
, Barchetti
F
, Sciarra
A
, Ciardi
A
, Indino
EL
, Papalia
R
, et al. Multiparametric magnetic resonance imaging vs. standard care in men being evaluated for prostate cancer: a randomized study
. Urol Oncol
. 2015
;33
(1
):17.e1
–7
. .15.
Greer
MD
, Brown
AM
, Shih
JH
, Summers
RM
, Marko
J
, Law
YM
, et al. Accuracy and agreement of PIRADSv2 for prostate cancer mpMRI: a multireader study
. J Magn Reson Imaging
. 2017
;45
(2
):579
–85
. .16.
Bour
L
, Schull
A
, Delongchamps
NB
, Beuvon
F
, Muradyan
N
, Legmann
P
, et al. Multiparametric MRI features of granulomatous prostatitis and tubercular prostate abscess
. Diagn Interv Imaging
. 2013
;94
(1
):84
–90
. .17.
Rosenkrantz
AB
, Taneja
SS
. Radiologist, be aware: ten pitfalls that confound the interpretation of multiparametric prostate MRI
. AJR Am J Roentgenol
. 2014
;202
(1
):109
–20
. .18.
Noworolski
SM
, Vigneron
DB
, Chen
AP
, Kurhanewicz
J
. Dynamic contrast-enhanced MRI and MR diffusion imaging to distinguish between glandular and stromal prostatic tissues
. Magn Reson Imaging
. 2008
;26
(8
):1071
–80
. .19.
Truong
M
, Wang
B
, Gordetsky
JB
, Nix
JW
, Frye
TP
, Messing
EM
, et al. Multi-institutional nomogram predicting benign prostate pathology on magnetic resonance/ultrasound fusion biopsy in men with a prior negative 12-core systematic biopsy
. Cancer
. 2018
;124
(2
):278
–85
. .20.
Radtke
JP
, Wiesenfarth
M
, Kesch
C
, Freitag
MT
, Alt
CD
, Celik
K
, et al. Combined clinical parameters and multiparametric magnetic resonance imaging for advanced risk modeling of prostate cancer-patient-tailored risk stratification can reduce unnecessary biopsies
. Eur Urol
. 2017
;72
(6
):888
–96
. .21.
Distler
FA
, Radtke
JP
, Bonekamp
D
, Kesch
C
, Schlemmer
HP
, Wieczorek
K
, et al. The value of PSA density in combination with PI-RADS for the accuracy of prostate cancer prediction
. J Urol
. 2017
;198
(3
):575
–82
. .22.
Washino
S
, Okochi
T
, Saito
K
, Konishi
T
, Hirai
M
, Kobayashi
Y
, et al. Combination of prostate imaging reporting and data system (PI-RADS) score and prostate-specific antigen (PSA) density predicts biopsy outcome in prostate biopsy naive patients
. BJU Int
. 2017
;119
(2
):225
–33
.23.
Kubota
Y
, Kamei
S
, Nakano
M
, Ehara
H
, Deguchi
T
, Tanaka
O
. The potential role of prebiopsy magnetic resonance imaging combined with prostate-specific antigen density in the detection of prostate cancer
. Int J Urol
. 2008
;15
(4
):322
–6
. discussion 327
. .© 2021 S. Karger AG, Basel
2021
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
