title: Early experience with multiparametric magnetic resonance imaging-targeted biopsies under visual transrectal ultrasound guidance in patients suspicious for prostate cancer undergoing repeated biopsy.
abstract: OBJECTIVE
  The purpose of this study was to investigate the detection rate of prostate cancer (PCa) by multiparametric magnetic resonance imaging-targeted biopsies (mp-MRI-bx) in patients with prior negative transrectal ultrasound biopsy (TRUS-bx) sessions without previous experience of this.
  
  
  METHODS
  Eighty-three patients with prior negative TRUS-bx scheduled for repeated biopsies due to persistent suspicion of PCa were prospectively enrolled. mp-MRI was performed before biopsy and all lesions were scored according to the Prostate Imaging Reporting and Data System (PI-RADS) and Likert classification. All underwent repeated TRUS-bx (10 cores) and mp-MRI-bx under visual TRUS guidance of any mp-MRI-suspicious lesion not targeted by systematic TRUS-bx.
  
  
  RESULTS
  PCa was found in 39 out of 83 patients (47%) and mp-MRI identified at least one lesion with some degree of suspicion in all 39 patients. Both PI-RADS and Likert scoring showed a high correlation between suspicion of malignancy and biopsy results (p < 0.0001). Five patients (13%) had cancer detected only on mp-MRI-bx outside the TRUS-bx areas (p = 0.025) and another seven patients (21%) had an overall Gleason score upgrade of at least one grade based on the mp-MRI-bx. Secondary PCa lesions not visible on mp-MRI were detected by TRUS-bx in six out of 39 PCa patients. The secondary foci were all Gleason 6 (3 + 3) in 5-10% of the biopsy core. According to the Epstein criteria, 37 out of 39 cancer patients were classified as clinically significant.
  
  
  CONCLUSIONS
  Using mp-MRI, even without previous experience, can improve the detection rate of significant PCa at repeated biopsy and allows more accurate Gleason grading.
authors.affiliation: Departments of Urology.
authors.forename: Lars
authors.initials: L
authors.lastname: Boesen
authors.forename: Nis
authors.initials: N
authors.lastname: Noergaard
authors.forename: Elizaveta
authors.initials: E
authors.lastname: Chabanova
authors.forename: Vibeke
authors.initials: V
authors.lastname: Logager
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Balslev
authors.forename: Kari
authors.initials: K
authors.lastname: Mikines
authors.forename: Henrik S
authors.initials: HS
authors.lastname: Thomsen
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000368:Aged; D062005:Biopsy, Large-Core Needle; D015331:Cohort Studies; D006801:Humans; D061705:Image-Guided Biopsy; D007610:Kallikreins / Q000097:blood; D008279:Magnetic Resonance Imaging; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D019048:Prostatic Intraepithelial Neoplasia / Q000175:diagnosis*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: multiparametric MRI; prostate biopsy; prostate cancer; targeted biopsy; transrectal ultrasound; visual fusion