title: Accuracy of endorectal magnetic resonance/transrectal ultrasound fusion for detection of prostate cancer during brachytherapy.
abstract: OBJECTIVE
  To evaluate the effectiveness of 3 Tesla endorectal magnetic resonance imaging (erMRI) with fusion to real-time transrectal ultrasound to detect a dominant cancer focus within the prostate gland.
  
  
  METHODS
  The safety and effectiveness of identifying suspicious lesions using erMRI was assessed in men undergoing brachytherapy perineal implants. Suspicious lesions identified on erMRI fused to real-time transrectal ultrasound were biopsied at brachytherapy seed placement. In addition, a biopsy was also obtained from an area identified as negative for cancer. This prospective study was performed for 30 patients who had previously provided consent for brachytherapy. Eligible patients had to have a lesion on erMRI that was ≥1.0 cm × 1.0 cm. Their mean prostate-specific antigen level was 7.3 ng/mL, mean Gleason score 6.75, and mean percentage of positive diagnostic core biopsies was 29%.
  
  
  RESULTS
  Cancer was detected in a suspicious area in 53% of the patients. In 9 of these patients, the cancer was Gleason score 3 + 3, in 6, Gleason score 3 + 4, and in 1, Gleason score 4 + 3. Cancer was detected in unsuspected areas in 10% of patients; all Gleason score 3 + 3 in <10% of the core. No adverse events from the biopsy were reported.
  
  
  CONCLUSIONS
  Although biopsy of lesions identified by erMRI is safe and more effective than would be expected by blind biopsy, a significant "miss" rate was still found. However, the negative predictive (10%) value of this technique might be useful for determining which regions of the gland might not need treatment in the setting of focal therapy.
authors.affiliation: Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. gbubley@bidmc.harvard.edu
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Bubley
authors.forename: B N
authors.initials: BN
authors.lastname: Bloch
authors.forename: Cesar
authors.initials: C
authors.lastname: Vazquez
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Genega
authors.forename: Ed
authors.initials: E
authors.lastname: Holupka
authors.forename: Neil
authors.initials: N
authors.lastname: Rofsky
authors.forename: Irving
authors.initials: I
authors.lastname: Kaplan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D061705:Image-Guided Biopsy / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy; D012007:Rectum; D018084:Ultrasonography, Interventional