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.
BACKGROUND
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.


OBJECTIVE
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.


METHODS
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.


METHODS
Patients underwent MRGB of MP-MRI CSRs.


METHODS
(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.


CONCLUSIONS
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).


CONCLUSIONS
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%).
Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. C.Hoeks@rad.umcn.nl
Caroline M A
CM
Hoeks
Martijn G
MG
Schouten
Joyce G R
JG
Bomers
Stefan P
SP
Hoogendoorn
Christina A
CA
Hulsbergen-van de Kaa
Thomas
T
Hambrock
Henk
H
Vergunst
J P Michiel
JP
Sedelaar
Jurgen J
JJ
Fütterer
Jelle O
JO
Barentsz
D000368:Aged; D016009:Chi-Square Distribution; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D007610:Kallikreins / Q000097:blood*; D016015:Logistic Models; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009426:Netherlands; D011237:Predictive Value of Tests; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D012017:Referral and Consultation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D047368:Tumor Burden; D018084:Ultrasonography, Interventional; D015854:Up-Regulation
C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen