title: Combined multiparametric MRI and targeted biopsies improve anterior prostate cancer detection, staging, and grading.
abstract: OBJECTIVE
  To assess the efficacy of magnetic resonance imaging (MRI) in detection of suspicious anterior prostate lesions, and its role in staging and grading of anterior prostate cancer (APC).
  
  
  METHODS
  Between January 2008 and August 2009, 243 patients had prostate cancer diagnosed at 12-cores posterior systematic biopsies and additional 2-cores transrectal ultrasound-guided, free-hand-targeted biopsy at any area suspicious for malignancy at prebiopsy multiparametric MRI. We conducted a retrospective study of 45 of 243 (19%) patients with an area suspicious for malignancy at MRI predominantly located in the anterior part of the gland, for which targeted biopsies were positive. Targeted vs systematic biopsy cancer detection rate and upgrading based on length of cancer in the most involved core and Gleason score were measured.
  
  
  RESULTS
  Of the 45 patients, 46 separate APCs were identified at MRI with positive targeted biopsies. APC was not detected by systematic biopsies in 21 (46%) cases and detected in 25 (54%) cases. For these 25 cases, median cancer length of the most involved core in targeted compared with systematic biopsies was 8 mm vs 1 mm (P <.001), respectively. Significant Gleason score upgrading was observed in 11 of 25 (44%) cases. Correlation coefficient between the cancer length on targeted biopsies and the antero-posterior diameter of the area suspicious for malignancy on MRI was r(2) = .6 (P <.001). Separate posterior cancer was diagnosed in 26 patients.
  
  
  CONCLUSIONS
  Targeted biopsies based on a prebiopsy MRI-detected lesion improved detection rate, volume, and grade of APC compared with currently used 12-cores systematic biopsies.
authors.affiliation: Department of Urology, CHU, University Lille, France. adil-ouzzane@orange.fr
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
authors.forename: Philippe
authors.initials: P
authors.lastname: Puech
authors.forename: Laurent
authors.initials: L
authors.lastname: Lemaitre
authors.forename: Xavier
authors.initials: X
authors.lastname: Leroy
authors.forename: Pierre
authors.initials: P
authors.lastname: Nevoux
authors.forename: Nacim
authors.initials: N
authors.lastname: Betrouni
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional