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INTRODUCTION AND OBJECTIVES: Precise localization of tumor locus is critically important for successful focal therapy in prostate cancer. The accuracy of multiparametric MRI (mpMRI) for prostate cancer localization is still unknown. METHODS: We retrospectively analyzed 176 prostate cancer patients who underwent preoperative 3.0T multiparametric MRI (mpMRI) followed by radical prostatectomy (RP) without neoadjuvant androgen deprivation. Images of mpMRI was evaluated by a single radiologist based on PI-RADS version 2. PI-RADS score 4 or greater was considered positive. Tumor distribution was evaluated on radical prostatectomy specimen sliced at 5-mm thick and tumor volume was estimated based on planimetry. RESULTS: Of the 176 study patients, 79 (45%) had negative mpMRI. Patients with negative mpMRI had smaller index tumor compared with those with positive mpMRI with a marginal significance (1.79 0.25 vs 20.5 0.22 cc., p 1⁄4 0.05, Figure and Table). They were also more likely to have clinically insignificant cancer (Gleason score 6 and tumor volume <0.5 cc.) compared with those with positive mpMRI (Tables). However, the sensitivity and specificity for clinically significant prostate cancer was only 60% and 57%, respectively, indicating that mpMRI missed 40% of clinically significant cancer. CONCLUSIONS: Although negative mpMRI is associated with favorable pathological findings in prostate cancer patients who underwent radical prostatectomy, mpMRI could not safely exclude clinically significant index tumor. Further improvement in the accuracy for tumor localization is warranted for the possible application of mpMRI to plan focal therapy.

the journal of urology/the journal of urology

MP20-10 THE ACCURACY OF MAGNETIC RESONANCE IMAGING (MPMRI) GUIDED TRANSPERINEAL FUSION PROSTATE BIOPSIES (TPFB) TO EVALUATE LESIONS ON PROSTATE MPMRI USING PROSTATECTOMY SPECIMENS AS A VALIDATION TOOL.