Multi-parametric 3-Tesla MRI evaluation of prostate in cases with negative prostatic biopsy with raised PSA levels - A tertiary care hospital study

The incidence of prostate cancer has been gradually increasing in the world. Checking the serum prostate-specific antigen (PSA) level and a digital rectal examination (DRE) are the gold standards for prostate cancer screening. Prostate gland is divided into four zones, the peripheral zone (PZ), transitional zone and central zone and anterior nonglandular fibromuscular stroma. Prostate is divided into minimum 16 and optionally 27 regions of interest as per European consensus meeting. Until recently, most professionals have been skeptical that magnetic resonance imaging (MRI) could be used on a widespread basis to diagnose or stage prostate cancer with any degree of reliability, and therefore help with making treatment decisions. The aim of the present study was to study diagnostic value of mpMRI of prostate in cases of raised PSA but with negative biopsy. The present study was carried out in the post graduate department of Radiodiagnosis and imaging Govt. Medical College Srinagar over a period of one year from May 2016 to April 2017. All patients with negative prostatic biopsy were evaluated on Siemens 3 tesla MRI scanner. All patients underwent initial T1W scanning to look for any evidence of hemorrhage and patients having hemorrhage due to previous biopsy were also excluded from study or their study was deferred until hemorrhagic artifacts disappear. After proper case selection patients were subjected to detail Multiparametric MRI (mpMRI) for prostate 6-8 weeks period was given from previous biopsy time to MRI study and cases with hemorrhage on T1 weighted sequence were either excluded from study or their study was deferred till resolution of haemorrhage. The conclusion of the present study was that Mp-MRI prior to repeat biopsies can improve the detection rate of clinically significant PCa and allow for a more accuracy in prostate disease diagnosis.