title: High diagnostic ability of multiparametric magnetic resonance imaging to detect anterior prostate cancer missed by transrectal 12-core biopsy.
abstract: OBJECTIVE
  We clarified the diagnostic ability of multiparametric magnetic resonance imaging to reveal anterior cancer missed by transrectal 12-core prostate biopsy based on the results of 3-dimensional 26-core prostate biopsy, which is a combination of transrectal 12-core and transperineal 14-core biopsies.
  
  
  METHODS
  The study population consisted of 324 patients who prospectively underwent prebiopsy multiparametric magnetic resonance imaging and then 3-dimensional 26-core prostate biopsy at a single institution. We defined transrectal 12-core negative cancer as cancer detected by transperineal 14-core but not transrectal 12-core prostate biopsy. We focused on cancer in the anterior region. Any findings suspicious for malignancy in the region anterior to the urethra on multiparametric magnetic resonance imaging were defined as an anterior lesion on imaging. Significant cancer was defined as a biopsy Gleason score of 4 + 3 or greater, a greater than 20% positive core and/or a maximum cancer length of 5 mm or greater. Associations between an anterior lesion on imaging and transrectal 12-core negative cancer were investigated.
  
  
  RESULTS
  The overall cancer detection rate on 3-dimensional 26-core prostate biopsy was 39% (128 of 324 cases), of which 28% (36 of 128) were transrectal 12-core negative cancers. An anterior lesion on prebiopsy multiparametric magnetic resonance imaging was identified in 20% of men overall (65 of 324). Of men with and without an anterior lesion on imaging 40% (26 of 65) and 3.8% (10 of 259), respectively, had transrectal 12-core negative cancer. Significant transrectal 12-core negative cancer was observed in 0.4% (1 of 259 men) without an anterior lesion on imaging. Prebiopsy multiparametric magnetic resonance imaging revealed an anterior lesion in 92% of cases (11 of 12) of significant transrectal 12-core negative cancer.
  
  
  CONCLUSIONS
  Prebiopsy multiparametric magnetic resonance imaging has the potential to efficiently select men who could advantageously undergo anterior samplings, in addition to transrectal 12-core prostate biopsy.
authors.affiliation: Department of Urology, Graduate School, Tokyo Medical and Dental University and Department of Radiology, Ochanomizu Surugadai Clinic (CI), Tokyo, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Komai
authors.forename: Noboru
authors.initials: N
authors.lastname: Numao
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yoshida
authors.forename: Yoh
authors.initials: Y
authors.lastname: Matsuoka
authors.forename: Yasukazu
authors.initials: Y
authors.lastname: Nakanishi
authors.forename: Chikako
authors.initials: C
authors.lastname: Ishii
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Koga
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Saito
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawakami
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
mesh_terms: D000368:Aged; D062005:Biopsy, Large-Core Needle; D015331:Cohort Studies; D003951:Diagnostic Errors; D006801:Humans; D021621:Imaging, Three-Dimensional; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness / Q000473:pathology; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology*; D012007:Rectum / Q000601:surgery; D018570:Risk Assessment; D012680:Sensitivity and Specificity
keywords: 3-dimensional 26-core prostate biopsy; 3D26PBx; DCEI; DRE; DWI; MP-MRI; MRI; PCa; PSA; T2-weighted imaging; T2WI; TP14PBx; TR12; TR12 prostate biopsy; TR12PBx; biopsy; diagnosis; diagnostic imaging; diffusion-weighted imaging; digital rectal examination; dynamic contrast enhanced imaging; magnetic resonance imaging; multiparametric MRI; prostate; prostate cancer; prostate specific antigen; transperineal 14-core prostate biopsy; transrectal 12-core