title: Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging.
abstract: OBJECTIVE
  A novel platform was developed that fuses pre-biopsy magnetic resonance imaging with real-time transrectal ultrasound imaging to identify and biopsy lesions suspicious for prostate cancer. The cancer detection rates for the first 101 patients are reported.
  
  
  METHODS
  This prospective, single institution study was approved by the institutional review board. Patients underwent 3.0 T multiparametric magnetic resonance imaging with endorectal coil, which included T2-weighted, spectroscopic, dynamic contrast enhanced and diffusion weighted magnetic resonance imaging sequences. Lesions suspicious for cancer were graded according to the number of sequences suspicious for cancer as low (2 or less), moderate (3) and high (4) suspicion. Patients underwent standard 12-core transrectal ultrasound biopsy and magnetic resonance imaging/ultrasound fusion guided biopsy with electromagnetic tracking of magnetic resonance imaging lesions. Chi-square and within cluster resampling analyses were used to correlate suspicion on magnetic resonance imaging and the incidence of cancer detected on biopsy.
  
  
  RESULTS
  Mean patient age was 63 years old. Median prostate specific antigen at biopsy was 5.8 ng/ml and 90.1% of patients had a negative digital rectal examination. Of patients with low, moderate and high suspicion on magnetic resonance imaging 27.9%, 66.7% and 89.5% were diagnosed with cancer, respectively (p <0.0001). Magnetic resonance imaging/ultrasound fusion guided biopsy detected more cancer per core than standard 12-core transrectal ultrasound biopsy for all levels of suspicion on magnetic resonance imaging.
  
  
  CONCLUSIONS
  Prostate cancer localized on magnetic resonance imaging may be targeted using this novel magnetic resonance imaging/ultrasound fusion guided biopsy platform. Further research is needed to determine the role of this platform in cancer detection, active surveillance and focal therapy, and to determine which patients may benefit.
authors.affiliation: Urologic Oncology Branch, Clinical Center & National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1210, USA. pintop@mail.nih.gov
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
authors.forename: Paul H
authors.initials: PH
authors.lastname: Chung
authors.forename: Ardeshir R
authors.initials: AR
authors.lastname: Rastinehad
authors.forename: Angelo A
authors.initials: AA
authors.lastname: Baccala
authors.forename: Jochen
authors.initials: J
authors.lastname: Kruecker
authors.forename: Compton J
authors.initials: CJ
authors.lastname: Benjamin
authors.forename: Sheng
authors.initials: S
authors.lastname: Xu
authors.forename: Pingkun
authors.initials: P
authors.lastname: Yan
authors.forename: Samuel
authors.initials: S
authors.lastname: Kadoury
authors.forename: Celene
authors.initials: C
authors.lastname: Chua
authors.forename: Julia K
authors.initials: JK
authors.lastname: Locklin
authors.forename: Baris
authors.initials: B
authors.lastname: Turkbey
authors.forename: Joanna H
authors.initials: JH
authors.lastname: Shih
authors.forename: Stacey P
authors.initials: SP
authors.lastname: Gates
authors.forename: Carey
authors.initials: C
authors.lastname: Buckner
authors.forename: Gennady
authors.initials: G
authors.lastname: Bratslavsky
authors.forename: W Marston
authors.initials: WM
authors.lastname: Linehan
authors.forename: Neil D
authors.initials: ND
authors.lastname: Glossop
authors.forename: Peter L
authors.initials: PL
authors.lastname: Choyke
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Wood
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D006801:Humans; D008279:Magnetic Resonance Imaging; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D018084:Ultrasonography, Interventional