title: Magnetic resonance imaging guided prostate biopsy in men with repeat negative biopsies and increased prostate specific antigen.
abstract: OBJECTIVE
  Undetected cancer in repeat transrectal ultrasound guided prostate biopsies in patients with increased prostate specific antigen greater than 4 ng/ml is a considerable concern. We investigated the tumor detection rate of tumor suspicious regions on multimodal 3 Tesla magnetic resonance imaging and subsequent magnetic resonance imaging guided biopsy in 68 men with repeat negative transrectal ultrasound guided prostate biopsies. We compared results to those in a matched transrectal ultrasound guided prostate biopsy population. Also, we determined the clinical significance of detected tumors.
  
  
  METHODS
  A total of 71 consecutive patients with prostate specific antigen greater than 4 ng/ml and 2 or greater negative transrectal ultrasound guided prostate biopsy sessions underwent multimodal 3 Tesla magnetic resonance imaging. In 68 patients this was followed by magnetic resonance imaging guided biopsy directed toward tumor suspicious regions. A matched multisession transrectal ultrasound guided prostate biopsy population from our institutional database was used for comparison. The clinical significance of detected tumors was established using accepted criteria, including prostate specific antigen, Gleason grade, stage and tumor volume.
  
  
  RESULTS
  The tumor detection rate of multimodal 3 Tesla magnetic resonance imaging guided biopsy was 59% (40 of 68 cases) using a median of 4 cores. The tumor detection rate was significantly higher than that of transrectal ultrasound guided prostate biopsy in all patient subgroups (p <0.01) except in those with prostate specific antigen greater than 20 ng/ml, prostate volume greater than 65 cc and prostate specific antigen density greater than 0.5 ng/ml/cc, in which similar rates were achieved. Of the 40 patients with identified tumors 37 (93%) were considered highly likely to harbor clinically significant disease.
  
  
  CONCLUSIONS
  Multimodal magnetic resonance imaging is an effective technique to localize prostate cancer. Magnetic resonance imaging guided biopsy of tumor suspicious regions is an accurate method to detect clinically significant prostate cancer in men with repeat negative biopsies and increased prostate specific antigen.
authors.affiliation: University Medical Centre St Radboud, Nijmegen, The Netherlands.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hambrock
authors.forename: Diederik M
authors.initials: DM
authors.lastname: Somford
authors.forename: Caroline
authors.initials: C
authors.lastname: Hoeks
authors.forename: Stefan A W
authors.initials: SA
authors.lastname: Bouwense
authors.forename: Henkjan
authors.initials: H
authors.lastname: Huisman
authors.forename: Derya
authors.initials: D
authors.lastname: Yakar
authors.forename: Inge M
authors.initials: IM
authors.lastname: van Oort
authors.forename: J Alfred
authors.initials: JA
authors.lastname: Witjes
authors.forename: Jurgen J
authors.initials: JJ
authors.lastname: Fütterer
authors.forename: Jelle O
authors.initials: JO
authors.lastname: Barentsz
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D005188:False Negative Reactions; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography
chemical_list: D017430:Prostate-Specific Antigen