The effect of MRI directed diagnostic pathway in suspected prostate cancer biopsy naive men according to PI-RADS V2.1 score.

Mostafa Adly EL Beeh, Radiology department, Urology and Nephrology Center, Mansoura University, Egypt.Follow
Magda Hany EL Bakry, Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Mohamed E. EL Azab, Radiology department, Urology and Nephrology Center, Mansoura University, Egypt.
Farah A . Shokeir, Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Subject Area

Radiodiagnosis

Article Type

Original Study

Abstract

Objectives: -

To evaluate how an magnetic resonance imaging (MRI) -directed pathway and categorized prostatic specific antigen density (PSAD) can reduce the number of unnecessary prostate biopsies in biopsy-naïve men who are suspected to have prostate cancer while also improving the detection of clinically significant prostate cancer (csPCa) by using bi-parametric MRI (bp-MRI) as a triage method and analyzing the results based on the prostate imaging reporting data system version 2.1 ( PI-RADS V2.1 ) scoring system.

Subjects and methods:

Our prospective study was composed of 113 male patients who were suspected of having prostatic cancer either clinically {hard nodules by digital rectal examination (DRE)} or laboratorily {high serum prostatic specific antigen (PSA) > 4 ng/dl} and was performed during the period from December 2024 to January 2026. Following a thorough history, clinical examination, and laboratory investigations, all patients underwent DRE and bp-MRI study, which included diffusion-weighted imaging with ADC map using a 3-tesla MRI scanner and high-resolution T2WI (axial, coronal, and sagittal). The PI-RADS v2.1 scoring method and risk stratification based on estimated classified prostatic specific antigen density were used to further categorize the patients. Therefore, TRUS with immediate biopsy for high-risk patients of PIRADS 2 and 3 lesions with PSAD equal to or more than 0.15 , PIRADS 4 and 5 lesions regardless their calculated PSAD and no immediate biopsy with active surveillance by PSA for low-risk patients of PIRADS 2, and 3 lesions with PSAD less than 0.15 and no biopsy for PIRADS 1 lesions .

Results:

Out of 113 patients, the pathway allowed initially 32 men (28.3%) to avoid immediate biopsy with only one patient (0.9%) was diagnosed with csPCa during a 12-month follow-up, resulting in a final avoidance rate of 27.43%, as regarding the diagnostic performance our combined diagnostic pathway (bp-MRI and categorical PSAD, demonstrated a sensitivity of 98.2% (95% CI: 94.8%–100%), a specificity of 55.4% (95% CI: 42.3%–68.5%), and an overall accuracy of 77.0% (95% CI: 69.2%–84.8%) The Negative Predictive Value (NPV) was 96.9% (95% CI: 90.9%–100%)

Conclusion:

Pre-biopsy biparametric MRI (bpMRI) combined with a categorical PSAD of cutoff of (≥0.15) appears safe during a one-year of follow-up for triaging high-risk patient, significantly reducing unnecessary biopsies while maintaining high diagnostic accuracy.

Recommended Citation

EL Beeh, Mostafa Adly; EL Bakry, Magda Hany; EL Azab, Mohamed E.; and Shokeir, Farah A . (2026) "The effect of MRI directed diagnostic pathway in suspected prostate cancer biopsy naive men according to PI-RADS V2.1 score.," Mansoura Medical Journal: Vol. 56 : Iss. 3 , Article 4.
Available at: https://doi.org/10.58775/2735-3990.1613