Efficacy of Pelvic Diffusion Weighted MRI Prior to Prostate Biopsy in Patients with elevated tPSA Level for Determination of Malignant Lesions

Abstract

https://ejmr.journals.ekb.eg/committee of Beni-Suef was taken.Results: There were 72% of the studied patients had benign prostatic lesions and 28% had malignant lesions.There was a statistically significant higher level of PSA among patients with restricted MRI diffusion than who had normal MRI diffusion (P-value=0.030).The sensitivity of MRI diffusion in detection of malignant prostate masses was 71.4% its specificity was 94.4% %, the PPV was 83.3% and the NPV was 89.5%.

Conclusion:
In conclusion, transrectal ultrasonography (TRUS) guided biopsy samples from pre-determined lesions in diffusion-weighted MRI (MRI) resulted in an increase in the detection rate of prostate cancer while lowering the excessive biopsy rate.‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ ‫ـــــــــــــــــــــــــــــــــــــــــ‬ ‫ـــــــــــــــــــــــــــــــــــــــــــــ‬ ‫ـــــــــــــــــ‬ ‫ـــــــــــــ‬

Introduction:
In the Nordic nations, prostate cancer (PCa) is the second greatest cause of cancer-related death and the most often diagnosed male malignancy.A man's lifetime chance of being diagnosed with PCa is around 17% (one in six), but just 3% (one in thirty) will die from it, indicating that the majority of men with PCa never acquire a clinically severe condition that would influence their morbidity or mortality [1].
Urologists discovered that people diagnosed with prostate cancer had a negative biopsy despite a normal PSA level and abnormal rectal examination, posing diagnostic problems [2].
Due to random sampling error (repeat biopsies using the same technique will detect tumor in around a quarter of cases) and the fact that up to a third of significant tumors are found in the anterior part of the gland, based on studies of radical prostatectomy specimens, transrectal biopsy may miss significant prostate cancers [3].
Different studies have shown that men with a negative biopsy but a consistently increased PSA level are more likely to develop malignancies.Research that used systematic trans perineal mapping biopsy https://ejmr.journals.ekb.eg/found malignancy in 57% of the cases, with most positive cores located anteriorly.When magnetic resonance imaging (MRI) data were utilized to target biopsy, 40% to 59% of males were found to have tumors [4].
In the detection and characterization of prostate cancer, multi-parametric magnetic resonance imaging (MP-MRI) has become an increasingly significant technique [5].
In patients with low-risk prostate cancer who have outstanding oncologic results, active monitoring has recently become a viable therapy option [6].
Diffusion-weighted MRI has been shown to be better than dynamic contrast-enhanced MRI in the diagnosis of prostate cancer in many trials [7].
According to some investigators, Gleason score based on prostatectomy sections associated better with targeted biopsy based on DWI results than Gleason score based on biopsy cores of systematic 10-core transrectal ultrasound-guided prostate biopsy [8].
DWI has previously been used to effectively identify and characterize cancers in the peripheral and transitional zones [9].
So,the aim of this research to examine the influence of TRUS-guided biopsy samples from specified lesions in diffusion-weighted MRI on the detection rate of prostate cancer (MRI).

Patients and Methods:
Type of study: This study is a cross sectional analytical studywith follow up the results of biopsy.
This study conducted on 25 patients with elevated PSA from 2.5 to 20 ng/ml undergone diffusion weighted MRI before TRUS guided biopsy.

Site of study:
25 patients referred to the diagnostic radiology department from the outpatient clinic of urology department at Beni-Suef University Hospital

Date and period of study:
This study done from September 2018 to December 2020.

Ethical consideration:
The study explained to all participants and written informed consent taken from them before starting the study and the approval of

Procedure and technique:
All patients subjected to: 1. Full history taking as age, sex, symptoms, and any medical condition.
-General examination: • Many men have their first experience with prostate cancer screening at an annual physical screening.
• General signs of cancer as loss of weight, fatigue, pain, and cachexia -Urological examination: • Pain in the bottom part of the pelvis • Urinary incessantly • Inability to urinate, such as a painful, scorching, or weak flow.
• Blood in the urine (Hematuria) • Pain in ejaculation -Examination for any associated medical conditions.

Radiological investigations:
- of the two groups.The best PSA cutoff threshold for predicting prostatic cancer was determined using a receiver operating characteristic curve.The significance of the findings was determined using the P-value, which was classified as non-significant when the P-value was more than 0.05 and significant when the P-value was less than or equal 0.05.

Results:
Table (1) showed that the study included 25 patients with mean age 64.    a positive biopsy rate of 36.8%.[10].
Because standard sextant biopsy has a high probability of false negatives, we need more biopsy cores to boost prostate cancer diagnosis without increasing the number of needless biopsies [11].
Because roughly a quarter of tumors are found in the anterior region of the gland, and https://ejmr.journals.ekb.eg/ between a quarter and a third of tumors are found in the front section of the gland, major prostate malignancies are missed [12].
The posterior region of the prostate is oversampled by transrectal biopsy, whereas the anterior, distal, apical, midline, and subcapsular prostates are under sampled.
These locations may have clinically significant illness, which might change how patients are treated.The "prostatic evasive anterior tumor syndrome" (PEATS) is a kind of anterior tumor that is often overlooked with TRUS-guided biopsy [13].
Because necessitates an increase in the number of exclusions from evaluation [20].
Although the use of an endorectal coil (ERC) is not necessary, the use of an ERC enhances the scan quality and increases the expense and pain of the process [21].Gleason scores [25]. In

Conclusion:
In conclusion, transrectal ultrasonography (TRUS) guided biopsy samples from predetermined lesions in diffusion-weighted MRI (MRI) resulted in an increase in the detection rate of prostate cancer while lowering the excessive biopsy rate.

Recommendations:
According to the findings of this research, diffusion-weighted imaging should be employed in conjunction with conventional MRI sequences in the analysis of prostatic lesions, rather than as a stand-alone imaging study.Prostate tissue features may be studied https://ejmr.journals.ekb.eg/ using DWI in conjunction with T2WI, which is based on T2WI.
We further recommend that diffusion image be analyzed in combination with traditional sequences to avoid any possible mistakes or limits of the technology.
Also, we urge that future research be done out on the many uses of diffusion weighted method in the prostate, such as the evaluation of treatment response and the recurrence of the tumor, as well.

25 (
Patients underwent prostate MRI using SEIMENS Healthineers 1.5 Tesla with pelvic phased-array coil.Statistical Package for Social Science) for Windows was used to analyze the data.The mean and standard deviation were used to describe quantitative variables.Numbers (No.) and percentages were used to describe qualitative factors (percent).The Shapiro/ Kolmogorov tests of normalcy were used to examine the data for normality.https://ejmr.journals.ekb.eg/The independent t-test was used to analyze the comparison between the scale variables

Figure ( 1 )
Figure (1) Histopathological results of the studied biopsies Figure (1) showed that there were 72% of the studied patients had benign prostatic lesions and 28% had malignant lesions.

Figure ( 2
Figure (2) ROC curve for prediction of malignancy from PSA level However, the cost and time required to conduct an MPMRI screening research raises questions about whether the healthcare system can afford it.This might lead to the development of new diagnostic tools that are similar to the mammography for breast cancer, if the research is simplified.As a result, researchers looked into the diagnostic value of a bi-parametric MRI that only uses T2W, DWI sequences and requires half the in-bore magnet time of our institution's complete MPMRI while also removing the need for a contrast-enhanced study, which saves money and time by eliminating the need for an intravenous access catheter replacement for MR contrast agent administration [22].The combination of BMRI with PSA screening should help reduce the number of biopsies that produce benign results or clinically inconsequential illness, therefore directing resources toward men with more aggressive disease [23].DWI has previously been used effectively to identify and characterize cancers in the peripheral and transitional regions of the https://ejmr.journals.ekb.eg/brain [24].The high cellularity and abundance of intra and intercellular membranes in prostate cancer tissue results in diffusion limitation, making DWI a useful tool for detecting the disease.Furthermore, the use of DWI to measure tumor aggressiveness is garnering a lot of interest, despite the difficulty of accurately predicting

Table ( 4) Sensitivity, specificity, positive predictive value, and negative predictive value of the MRI diffusion in detection of malignant prostate masses based on biopsy: MRI Diffusion Biopsy result Total Negative malignancy Positive Malignancy Negative restriction
(4)le(4)showed that the sensitivity of MRI diffusion in detection of malignant prostate masses was 71.4% its specificity was 94.4% %, the PPV was 83.3% and the NPV was 89.5%.https://ejmr.journals.ekb.eg/