Objective:

To compare the diagnostic value of prostate imaging-reporting and data system (mpMRI) version 2.0 with classical parameters for prostate cancer detection in gray zone patients with ultrasonography-guided prostate biopsy as a reference point.

Materials and Methods:

With the retrospective nature of the study, 438 biopsy-naïve patients in the gray zone with pre-biopsy mpMRI were reviewed. Ultrasonography-guided transrectal prostate biopsy was the reference point. Diagnostic performance of classical parameters compared with mpMRI results for prostate carcinoma and clinically significant prostate carcinoma.

Results:

The overall cancer detection rate was 30%. Prostate-specific antigen density, free/total prostate-specific antigen ratio, prostate volume, suspicious digital rectal examination, and mpMRI score >3 were independent predictors of clinically significant prostate carcinoma. Prostatespecific antigen density followed by free/total prostate-specific antigen ratio had the largest area under the curve values compared with mpMRI score >3 for prostate carcinoma and clinically significant prostate carcinoma.

Conclusion:

Classical parameters, prostate-specific antigen density, and f/t prostate-specific antigen ratio were still critical to deciding prostate biopsy in gray zone patients, in whom ultrasonography-guided transrectal prostate biopsy was used as a reference point. In centers where targeted fusion biopsies were unavailable, pre-biopsy mpMRI still had some benefits. However, biopsy decisions should be made according to each patient’s individual characteristics.

Keywords: Prostate, biopsy, multiparametric prostate magnetic resonance imaging, prostate carcinoma