title: The feasibility of multiparametric magnetic resonance imaging for targeted biopsy using novel navigation systems to detect early stage prostate cancer: the preliminary experience.
abstract: OBJECTIVE
  The feasibility and diagnostic performance of multiparametric magnetic resonance imaging (mp-MRI) has to be proven further. In this study, we evaluate the role of mp-MRI for targeted biopsy of early stage prostate cancer (PCa).
  
  
  METHODS
  A total 32 consecutive patients with transrectal ultrasonography (TRUS)-guided biopsy-proven PCa meeting low-risk criteria and pursuing active surveillance were selected to undergo mp-MRI 3 Tesla (3T) with endorectal coil. Patients were divided then into three groups based on the method used to target the mp-MRI designated region of interest (ROI): Group 1 underwent TRUS-guided prostate biopsy using an MRI-based coordinate plan (cognitive targeting). Group 2 underwent MRI-targeted TRUS-guided prostate biopsy using MyLabTMTwice, which superimposed the archived MRI images onto the real-time ultrasonography image allowing targeted biopsy of the ROI (fusion targeting). Group 3 included selected patients who had an elevation in prostate-specific antigen levels, or patients followed after radiation therapy (two patients) for suspicious unifocal MRI lesion recurrence. These patients underwent MRI-guided biopsy of the suspicious ROI using the navigation system DynaTRIM.
  
  
  RESULTS
  The cancer detection rate in group 1 was 33.3% (3 of 10 patients), while in group 2, it was significantly higher at 46.2%. The sensitivity and specificity for group 1 was 45.5% and 33.3%, vs 61.9% and 20.8% in group 2, respectively. The positive predictive value in group 1 was 50.0% vs 53.8% in group 2 (P=0.04). In group 3, the cancer detection rate was much higher (80%) than in group 2, (P=0.005) although the majority of these patients (7 of 10) had a previously diagnosed prostate cancer on TRUS-guided 12-core biopsy.
  
  
  CONCLUSIONS
  Our preliminary experience of mp-MRI suggests the detection of early stage prostate cancer with low-risk features yields potential candidates for active surveillance or focal targeted therapy. The MRI-TRUS fusion system increases diagnostic yield compared with cognitive MRI-directed TRUS-guided biopsy.
authors.affiliation: Department of Urology/Surgery, University of Cincinnati, Cincinnati, Ohio 45267, USA. VMouraviev@ampofny.com
authors.forename: Vladimir
authors.initials: V
authors.lastname: Mouraviev
authors.forename: Sadhna
authors.initials: S
authors.lastname: Verma
authors.forename: Balaji
authors.initials: B
authors.lastname: Kalyanaraman
authors.forename: Qihui J
authors.initials: QJ
authors.lastname: Zhai
authors.forename: Krishnanath
authors.initials: K
authors.lastname: Gaitonde
authors.forename: Michael
authors.initials: M
authors.lastname: Pugnale
authors.forename: James F
authors.initials: JF
authors.lastname: Donovan
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000295:instrumentation; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D015203:Reproducibility of Results