# Study of the Correlation Between Multi-parametric MRI (MP-MRI) Prostate Findings and Transrectal Ultrasound (TRUS)-Guided Prostate Biopsy Results in Patients With Raised Serum PSA

## TL;DR

This study compares MRI and ultrasound-guided biopsy results in prostate cancer patients with high PSA levels, showing MRI's effectiveness in detecting cancer.

## Contribution

The study demonstrates the value of combining MRI-targeted and systematic biopsies for improved prostate cancer detection.

## Key findings

- MP-MRI showed 72.22% specificity and 87.5% sensitivity for detecting prostate cancer.
- Combining MRI-targeted and systematic biopsies improved cancer detection rates.
- PIRADS scoring correlated strongly with Gleason's score (p < 0.05).

## Abstract

Background

Prostate cancer requires early and accurate diagnosis to improve outcomes of various treatment modalities. Multi-parametric MRI (MP-MRI) has emerged as a non-invasive imaging modality for detecting and evaluating prostate cancer for histological diagnosis; however, transrectal ultrasound (TRUS)-guided biopsy is still the gold standard.

Aim

To study the correlation between MP-MRI prostate findings using Prostate Imaging Reporting and Data System (PIRADS) scoring and TRUS-guided prostate biopsy results, including Gleason’s score, in patients with raised serum PSA.

Materials and methods

The present prospective research comprises 66 patients aged 40-80 years with PSA >4 ng/ml or free-to-total PSA ratio <0.15, who attended the urology department at Pushpawati Singhania Research Institute, New Delhi, between May 2018 and March 2020. MP-MRI was performed on all patients, along with cognitive MP-MRI-targeted biopsy and systematic 12-core TRUS-guided biopsy. Gleason’s scoring and immunohistochemistry (IHC) were used to confirm malignancy.

Results

MP-MRI revealed that 71.21% of patients had probably malignant or malignant findings (PIRADS 4/5). TRUS biopsy confirmed malignancy in 72.7% of patients. Gleason's score and the PIRADS score showed a strong connection (p <0.05). MP-MRI showed a 72.22% specificity, 87.5% sensitivity, 68.42% negative predictive value (NPV), 89.36% positive predictive value (PPV), and 83.33% diagnostic accuracy for detecting prostate cancer. Cognitive MP-MRI-targeted biopsy detected cancer in 66.67% of patients, while systematic biopsy detected it in 56%. The combination of both methods yielded the highest diagnostic accuracy. Inter-rater kappa agreement between MP-MRI and the TRUS biopsy was moderately strong (κ = 0.587, p<0.001).

Conclusion

MP-MRI has been a highly sensitive and specific modality in identifying clinically significant prostate cancer. PI-RADS scoring offers a standardized and reproducible method for evaluating prostate lesions. A cognitive MP-MRI-targeted TRUS biopsy, especially in conjunction with systematic biopsy, significantly improves prostate cancer detection rates, especially in PIRADS 4 or higher cases.