title: Evolution of repeat prostate biopsy strategies incorporating transperineal and MRI-TRUS fusion techniques.
abstract: OBJECTIVE
  To test the hypothesis that MRI-TRUS fusion technique can increase the detection rate of prostate cancer (PC) in patients with previously negative biopsy.
  
  
  METHODS
  Patient records of men with persisting suspicion for PC after previous negative biopsy having undergone either extensive transrectal prostate biopsies (MD Anderson protocol; MDA), transperineal saturation (STP) or magnetic resonance imaging (MRI)/transrectal ultrasound (TRUS) fusion transperineal biopsies (MTTP) in three consecutive time intervals were reviewed retrospectively. The respective approach was the standard for the above indication at these episodes. In Cambridge, 70 patients underwent MDA biopsies, 75 STP underwent biopsies and 74 patients underwent MTTP biopsies. In total, 164 MTTP patients with the same indication from Heidelberg were analysed as reference standard. In total, 383 men were included into analysis. Low-grade PC was defined as Gleason score 7 (3 + 4) or lower.
  
  
  RESULTS
  Even though MTTP patients had significantly larger prostates, the overall cancer detection rate for PC was the highest in MTTP (24.2 % MDA, 41.3 % STP, 44.5 % MTTP, p = 0.027, Kruskal-Wallis test). The detection rate for clinically relevant high-grade PC was highest in MTTP; however, this did not reach statistical significance compared with MDA (23.5 % MDA, 12.9 % STP, 27.2 % MTTP, p = 0.25, Fischer's exact test). Comparing MTTP between Cambridge and Heidelberg, detection rates did not differ significantly (44.5 vs. 48 %, p = 0.58). There was a higher detection rate of high-grade cancer in Heidelberg. (36.3 vs. 27.2 %, p = 0.04).
  
  
  CONCLUSIONS
  Patients whom are considered for repeat biopsies may benefit from undergoing MRI-targeted TRUS fusion technique due to higher cancer detection rate of significant PC.
authors.affiliation: Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Timur H
authors.initials: TH
authors.lastname: Kuru
authors.forename: Kasra
authors.initials: K
authors.lastname: Saeb-Parsy
authors.forename: Andrea
authors.initials: A
authors.lastname: Cantiani
authors.forename: Julia
authors.initials: J
authors.lastname: Frey
authors.forename: Riccardo
authors.initials: R
authors.lastname: Lombardo
authors.forename: Eva
authors.initials: E
authors.lastname: Serrao
authors.forename: Gabriele
authors.initials: G
authors.lastname: Gaziev
authors.forename: Brendan
authors.initials: B
authors.lastname: Koo
authors.forename: Matthias
authors.initials: M
authors.lastname: Roethke
authors.forename: Vincent
authors.initials: V
authors.lastname: Gnanapragasam
authors.forename: Anne
authors.initials: A
authors.lastname: Warren
authors.forename: Andrew
authors.initials: A
authors.lastname: Doble
authors.forename: Boris
authors.initials: B
authors.lastname: Hadaschik
authors.forename: Christof
authors.initials: C
authors.lastname: Kastner
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D012007:Rectum; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D014463:Ultrasonography