Three-Tesla Magnetic Resonance–Guided Prostate Biopsy in Men With Increased Prostate-Specific Antigen and Repeated, Negative, Random, Systematic, Transrectal Ultrasound Biopsies: Detection of Clinically Significant Prostate Cancers

• Published in: European urology Vol. 62; no. 5; pp. 902 - 909
• Main Authors: Hoeks, Caroline M.A., Schouten, Martijn G., Bomers, Joyce G.R., Hoogendoorn, Stefan P., Hulsbergen-van de Kaa, Christina A., Hambrock, Thomas, Vergunst, Henk, Sedelaar, J.P. Michiel, Fütterer, Jurgen J., Barentsz, Jelle O.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.11.2012; Elsevier
• Subjects: Aged; Biological and medical sciences; Chi-Square Distribution; Gynecology. Andrology. Obstetrics; Humans; Image-Guided Biopsy - methods; Kallikreins - blood; Logistic Models; Magnetic resonance imaging; Magnetic Resonance Imaging, Interventional; Male; Male genital diseases; Medical sciences; Middle Aged; Multivariate Analysis; Neoplasm Grading; Neoplasm Staging; Nephrology. Urinary tract diseases; Netherlands; Predictive Value of Tests; Prognosis; Prostate biopsy; Prostate cancer; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Referral and Consultation; Retrospective Studies; Sensitivity and Specificity; Tumor Burden; Tumors; Tumors of the urinary system; Ultrasonography, Interventional; Up-Regulation; Urinary tract. Prostate gland; Urology; Magnetic resonance imaging; Prostate biopsy; Prostate cancer; Nephrology; Prostate disease; Male; Tumoral marker; Urology; Prostate specific antigen; Adult; Diagnosis; Urogenital system; Male genital diseases; Ultrasound; Repetition; Human; Urinary system disease; Magnetic resonance; Malignant tumor; Nuclear magnetic resonance imaging; Guidance; Anatomic pathology; Biopsy; Medical imagery; Prostate; Cancer
• ISSN: 0302-2838; 1873-7560; 1873-7560
• DOI: 10.1016/j.eururo.2012.01.047

Patients with elevated prostate-specific antigen (PSA) and one or more previous negative transrectal ultrasound (TRUS) biopsy sessions are subject to diagnostic uncertainty due to TRUS-biopsy undersampling. Magnetic resonance (MR)–guided biopsy (MRGB) has shown high prostate cancer (PCa)–detection rates in studies with limited patient numbers. Determine the detection rate of (clinically significant) PCa for MRGB of cancer-suspicious regions (CSRs) on 3-T multiparametric MR imaging (MP-MRI) in patients with elevated PSA and one or more negative TRUS-biopsy sessions. Of 844 patients who underwent 3-T MP-MRI in our referral centre between March 2008 and February 2011, 438 consecutive patients with a PSA >4.0 ng/ml and one negative TRUS-biopsy session or more were included. MRGB was performed in 265 patients. Exclusion criteria were existent PCa, endorectal coil use, and MP-MRI for indications other than cancer detection. Patients underwent MRGB of MP-MRI CSRs. (Clinically significant) MRGB cancer-detection rates were determined. Clinically significant cancer was defined by accepted (i.a. Epstein and d’Amico) criteria based on PSA, Gleason score, stage, and tumour volume. Follow-up PSA and histopathology were collected. Sensitivity analysis was performed for patients with MP-MRI CSRs without MRGB. In a total of 117 patients, cancer was detected with MRGB (n=108) or after negative MRGB (n=9). PCa was detected in 108 of 438 patients (25%) and in 41% (108 of 265) of MRGB patients. The majority of detected cancers (87%) were clinically significant. Clinically significant cancers were detected in seven of nine (78%) negative MRGB patients in whom PCa was detected during follow-up. Sensitivity analysis resulted in increased cancer detection (47–56%). Complications occurred in 0.2% of patients (5 of 265). In patients with elevated PSA and one or more negative TRUS-biopsy sessions, MRGB of MP-MRI CSRs had a PCa-detection rate of 41%. The majority of detected cancers were clinically significant (87%). In patients with an elevated prostate-specific antigen level and one or more previous negative, random, systematic, transrectal ultrasound biopsy sessions, magnetic resonance (MR)–guided biopsy of detected cancer-suspicious regions on 3-T multiparametric MR imaging had a detection rate of 41% for predominantly clinically significant prostate cancers (87%).