title: Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen.
abstract: BACKGROUND
  Conventional biopsy fails to detect the presence of some prostate cancers (PCas). Men with a prior negative biopsy but persistently elevated prostate-specific antigen (PSA) pose a diagnostic dilemma, as some harbor elusive cancer.
  
  
  OBJECTIVE
  To determine whether use of magnetic resonance-ultrasound (MR-US) fusion biopsy results in improved detection of PCa compared to repeat conventional biopsy.
  
  
  METHODS
  In a consecutive-case series, 105 subjects with prior negative biopsy and elevated PSA values underwent multiparametric magnetic resonance imaging (MRI) and fusion biopsy in an outpatient setting.
  
  
  METHODS
  Suspicious areas on multiparametric MRI were delineated and graded by a radiologist; MR-US fusion biopsy was performed by a urologist using the Artemis device; targeted and systematic biopsies were obtained regardless of MRI result.
  
  
  METHODS
  Detection rates of all PCa and clinically significant PCa (Gleason ≥3+4 or Gleason 6 with maximal cancer core length ≥4 mm) were determined. The yield of targeted biopsy was compared to systematic biopsy. The ability of an MRI grading system to predict clinically significant cancer was investigated. Stepwise multivariate logistic regression analysis was performed to determine predictors of significant cancer on biopsy.
  
  
  CONCLUSIONS
  Fusion biopsy revealed PCa in 36 of 105 men (34%; 95% confidence interval [CI], 25-45). Seventy-two percent of men with PCa had clinically significant disease; 21 of 23 men (91%) with PCa on targeted biopsy had significant cancer compared to 15 of 28 (54%) with systematic biopsy. Degree of suspicion on MRI was the most powerful predictor of significant cancer on multivariate analysis. Twelve of 14 (86%) subjects with a highly suspicious MRI target were diagnosed with clinically significant cancer.
  
  
  CONCLUSIONS
  MR-US fusion biopsy provides improved detection of PCa in men with prior negative biopsies and elevated PSA values. Most cancers found were clinically significant.
authors.affiliation: Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA. Electronic address: geoffsonn@gmail.com.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Sonn
authors.affiliation: Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Chang
authors.affiliation: Department of Biomedical Engineering, University of California, Los Angeles, Los Angeles, CA, USA; Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Natarajan
authors.affiliation: Department of Radiology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Margolis
authors.affiliation: Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Malu
authors.initials: M
authors.lastname: Macairan
authors.affiliation: Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lieu
authors.affiliation: Department of Pathology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Jiaoti
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Orthopedic Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Dorey
authors.affiliation: Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Reiter
authors.affiliation: Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Leonard S
authors.initials: LS
authors.lastname: Marks
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D005188:False Negative Reactions; D006801:Humans; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D017430:Prostate-Specific Antigen
keywords: Magnetic resonance imaging; Prostate biopsy; Prostate cancer; Ultrasound