Multiparametric magnetic resonance imaging and ultrasound fusion biopsy detect prostate cancer in patients with prior negative transrectal ultrasound biopsies.
OBJECTIVE
Patients with negative transrectal ultrasound biopsies and a persistent clinical suspicion are at risk for occult but significant prostate cancer. The ability of multiparametric magnetic resonance imaging/ultrasound fusion biopsy to detect these occult prostate lesions may make it an effective tool in this challenging scenario.


METHODS
Between March 2007 and November 2011 all men underwent prostate 3 T endorectal coil magnetic resonance imaging. All concerning lesions were targeted with magnetic resonance imaging/ultrasound fusion biopsy. In addition, all patients underwent standard 12-core transrectal ultrasound biopsy. Men with 1 or more negative systematic prostate biopsies were included in our cohort.


RESULTS
Of the 195 men with previous negative biopsies, 73 (37%) were found to have cancer using the magnetic resonance imaging/ultrasound fusion biopsy combined with 12-core transrectal ultrasound biopsy. High grade cancer (Gleason score 8+) was discovered in 21 men (11%), all of whom had disease detected with magnetic resonance imaging/ultrasound fusion biopsy. However, standard transrectal ultrasound biopsy missed 12 of these high grade cancers (55%). Pathological upgrading occurred in 28 men (38.9%) as a result of magnetic resonance imaging/ultrasound fusion targeting vs standard transrectal ultrasound biopsy. The diagnostic yield of combined magnetic resonance imaging/ultrasound fusion platform was unrelated to the number of previous negative biopsies and persisted despite increasing the number of previous biopsy sessions. On multivariate analysis only prostate specific antigen density and magnetic resonance imaging suspicion level remained significant predictors of cancer.


CONCLUSIONS
Multiparametric magnetic resonance imaging with a magnetic resonance imaging/ultrasound fusion biopsy platform is a novel diagnostic tool for detecting prostate cancer and may be ideally suited for patients with negative transrectal ultrasound biopsies in the face of a persistent clinical suspicion for cancer.
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda MD.
Srinivas
S
Vourganti
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda MD.
Ardeshir
A
Rastinehad
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda MD.
Nitin
N
Yerram
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda MD.
Jeffrey
J
Nix
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda MD.
Dmitry
D
Volkin
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda MD.
An
A
Hoang
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda MD.
Baris
B
Turkbey
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda MD.
Gopal N
GN
Gupta
Philips Research North America, Briarcliff Manor NY.
Jochen
J
Kruecker
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda MD.
W Marston
WM
Linehan
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda MD.
Peter L
PL
Choyke
Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda MD.
Bradford J
BJ
Wood
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda MD.|Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda MD.
Peter A
PA
Pinto
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography