Poor reproducibility of PIRADS score in two multiparametric MRIs before biopsy in men with elevated PSA.

PURPOSE: Since January 2015, all men referred to urologists in Norway due to elevated PSA or other suspicion of prostate cancer underwent multiparametric MRI (mpMRI) before prostate biopsy. At our hospital, patients and the initial MRI were assessed by an urologist and if deemed necessary, patients were referred to another institution for MR/US fusion biopsies. Before MR/US biopsy, patients underwent a second mpMRI. Since we noticed disagreement of these two mpMRIs before biopsy, we retrospectively assessed the level of agreement between the two mpMRIs from the two institutions. METHODS: During the first 6 months of 2015, 292 patients were referred to our outpatient clinic. We referred 126 patients of these to the other institution for MR/US fusion biopsy. The 2 mpMRIs were performed within 4 weeks. We analyzed MR reports and schematics for number of lesions and highest PIRADS score per side of the prostate and histological result of the biopsies. Bland-Altman's plot was used to compare the level of agreement between the two mpMRIs of the same patient before biopsy. RESULTS: There was a poor level of agreement between the two mpMRIs and a statistically significant difference in PIRADS scores. Regression analysis showed that there was no proportional or systematic bias. CONCLUSION: In unselected patients with elevated PSA, there seems to be a significant variation of mpMRI results across institutions. The PIRADS scoring system needs to be validated with regards to MR equipment, mpMRI protocols and inter-reader variability of radiologists.

Can noninvasive evaluation of benign prostatic obstruction be optimized?

PURPOSE OF REVIEW: Lower urinary tract symptoms caused by benign prostatic obstruction is a common disorder and the incidence is increasing with higher life expectancy. The present article focuses on recently published methods to diagnose bladder outlet obstruction and differ between benign obstruction and prostate cancer in lower urinary tract symptoms patients. RECENT FINDINGS: Several new ultrasound imaging techniques have been reported. Resistive index in the prostatic artery, detrusor wall thickness and prostatic urethral angle all may correlate with obstruction, but more studies are needed to establish their place in clinical practice. Intravesical prostatic protrusion can predict obstruction and may be considered for clinical use. Near infrared spectroscopy has to be studied more to clarify its usefulness in clinical practice. There has been a rapid development of novel serum and urine-based biomarkers for prostate cancer in the last decade to differentiate between benign prostatic hyperplasia and prostate cancer. The recent studies with the use of prostate-specific antigen and urine prostate cancer gene 3 look promising. SUMMARY: Among promising new techniques in the investigation of prostatic obstruction, intravesical prostatic protrusion may be considered for clinical use. None of the methods described in recent studies can fully replace urodynamic investigation. Novel biomarkers in the future may help the clinicians to differentiate benign prostatic hyperplasia from prostate cancer.