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                <title xml:lang="en">What to expect from a non-suspicious prostate MRI? A review</title>
                <title xml:lang="fr">Que peut-on attendre d’une IRM prostatique non suspecte ? Une revue de la littérature</title>
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                <term xml:lang="en">Magnetic resonance imaging</term>
                <term xml:lang="en">Prostate biopsy</term>
                <term xml:lang="en">Prostate cancer</term>
                <term xml:lang="en">Risk factors</term>
                <term xml:lang="en">Negative predictive value</term>
                <term xml:lang="fr">Imagerie par résonance magnétique</term>
                <term xml:lang="fr">Valeur predictive negative</term>
                <term xml:lang="fr">Facteurs de risque</term>
                <term xml:lang="fr">Cancer de la prostate</term>
                <term xml:lang="fr">Biopsie prostatique</term>
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              <p>Background: Many guidelines now recommend multiparametric MRI (mpMRI) prior to an initial or repeat prostate biopsy. However, clinical decision making for men with a non-suspicious mpMRI (Likert or PIRADS score 1-2) varies.Objectives: To review the most recent literature to answer three questions. 1) Should we consider systematic biopsy if mpMRI is not suspicious? 2) Are there additional predictive factors that can help decide which patient should have a biopsy? 3) Can the low visibility of some cancers be explained and what are the implications?Sources: A narrative review was performed in Medline databases using two searches with the terms "MRI” AND “prostate cancer” AND (“diagnosis” OR “biopsy”) AND (“non-suspicious” OR “negative” OR “invisible”); “prostate cancer MRI visible”. References of the selected articles were screened for additional articles. Study selection: Studies published in the last 5 years in English language were assessed for eligibility and selected if data was available to answer one of the three study questions. Results: Considering clinically significant cancer as ISUP grade  2, the negative predictive value (NPV) of mpMRI in various settings and populations ranges from 76% to 99%, depending on cancer prevalence and the type of confirmatory reference test used. NPV is higher among patients with prior negative biopsy (88-96%), and lower for active surveillance patients (85-90%). The PSA density (PSAd) with a threshold of PSAd&lt;0.15ng/ml/ml was the most studied and relevant predictive factor used in combination with mpMRI to rule out clinically significant cancer. Finally, mpMRI-invisible tumours appear to differ from a histopathological and genetic point of view, conferring clinical advantage to invisibility.Limitations: Most published data come from expert centres and results may not be reproducible in all settings.Conclusion: mpMRI has high diagnostic accuracy and in cases of negative mpMRI, PSA density can be used to determine which patient should have a biopsy. Growing knowledge of the mechanisms and genetics underlying MRI visibility will help develop more accurate risk calculators and biomarkers.</p>
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              <p>Contexte : La réalisation d’une IRM multiparamétrique (IRMmp) est désormais recommandée avant la réalisation de biopsies prostatiques. En revanche, la conduite à tenir en présence d’une IRMmp non-suspecte (Score Likert ou PIRADS 1-2) est toujours débattue.Objectifs : Faire une synthèse de la littérature récente pour répondre à trois questions. 1) Faut-il réaliser des biopsies systématisées en présence d’une IRMmp non suspecte ? 2) Quels facteurs prédictifs permettent de définir les patients candidats à une biopsie systématisée ? 3) Le manque de visibilité de certains cancers peut-elle être expliquée et quelles en sont les conséquences cliniques ?Sources : Une revue narrative de la littérature a été réalisée à partir des bases de données Medline utilisant deux recherches avec les termes "MRI” AND “prostate cancer” AND (“diagnosis” OR “biopsy”) AND (“non-suspicious” OR “negative” OR “invisible”) ; “prostate cancer MRI visible”. Les références des articles sélectionnés ont été analysées à la recherche d’articles supplémentaires.Sélection des études : Les études publiées dans les 5 dernières années en anglais ont été analysées et retenues si les données disponibles permettaient de répondre à l’une des 3 questions posées.Résultats : Considérant les cancers de grade ISUP &gt;= 2 cliniquement significatifs, la valeur prédictive négative (VPN) de l’IRMmp était comprise entre 76% et 99%, dépendante de la prévalence du cancer et du type de test de référence utilisé. La VPN était plus élevée chez les patients aux antécédents de biopsie négative (88-96%), et plus faible chez les patients en surveillance active (85-90%). La densité de PSA (PSAd) avec un seuil de PSAd&lt;0.15ng/ml/ml était le facteur prédictif le plus étudié et le plus pertinent associé à l’IRMmp pour éliminer un cancer significatif. Enfin, les tumeurs non visibles à l’IRMmp présentaient des différences au niveau histopathologique et génétique, conférant un intérêt clinique à la visibilité IRM.Limites du travail : La plupart des données proviennent de centres experts et les résultats peuvent ne pas être reproductibles en dehors.Conclusion : L’IRMmp fait preuve de performances diagnostiques élevées pour éliminer un cancer cliniquement significatif. La densité de PSA peut être utilisée pour sélectionner patients devant avoir une biopsie. Une meilleure connaissance des mécanismes à l’origine de la visibilité du cancer devrait aider le développement de nomogrammes et biomarqueurs plus précis.</p>
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