title: Transperineal in-bore 3-T MR imaging-guided prostate biopsy: a prospective clinical observational study.
abstract: OBJECTIVE
  To determine the detection rate, clinical relevance, Gleason grade, and location of prostate cancer ( PCa prostate cancer ) diagnosed with and the safety of an in-bore transperineal 3-T magnetic resonance (MR) imaging-guided prostate biopsy in a clinically heterogeneous patient population.
  
  
  METHODS
  This prospective retrospectively analyzed study was HIPAA compliant and institutional review board approved, and informed consent was obtained. Eighty-seven men (mean age, 66.2 years ± 6.9) underwent multiparametric endorectal prostate MR imaging at 3 T and transperineal MR imaging-guided biopsy. Three subgroups of patients with at least one lesion suspicious for cancer were included: men with no prior PCa prostate cancer diagnosis, men with PCa prostate cancer who were undergoing active surveillance, and men with treated PCa prostate cancer and suspected recurrence. Exclusion criteria were prior prostatectomy and/or contraindication to 3-T MR imaging. The transperineal MR imaging-guided biopsy was performed in a 70-cm wide-bore 3-T device. Overall patient biopsy outcomes, cancer detection rates, Gleason grade, and location for each subgroup were evaluated and statistically compared by using χ(2) and one-way analysis of variance followed by Tukey honestly significant difference post hoc comparisons.
  
  
  RESULTS
  Ninety biopsy procedures were performed with no serious adverse events, with a mean of 3.7 targets sampled per gland. Cancer was detected in 51 (56.7%) men: 48.1% (25 of 52) with no prior PCa prostate cancer , 61.5% (eight of 13) under active surveillance, and 72.0% (18 of 25) in whom recurrence was suspected. Gleason pattern 4 or higher was diagnosed in 78.1% (25 of 32) in the no prior PCa prostate cancer and active surveillance groups. Gleason scores were not assigned in the suspected recurrence group. MR targets located in the anterior prostate had the highest cancer yield (40 of 64, 62.5%) compared with those for the other parts of the prostate (P < .001).
  
  
  CONCLUSIONS
  In-bore 3-T transperineal MR imaging-guided biopsy, with a mean of 3.7 targets per gland, allowed detection of many clinically relevant cancers, many of which were located anteriorly.
authors.affiliation: From the Division of MRI in the Department of Radiology (T.P., K.T., A.F., S.S., J.T., F.M.F., R.V.M., W.M.W., N.H., C.M.C.T.) and the Division of Urology (A.S.K.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany (T.P.). Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.G.V.); Department of Radiology, Dana-Farber Cancer Institute, Boston, Mass (F.M.F.); and Department of Radiology, Children's Hospital, Boston, Mass (R.V.M.).
authors.forename: Tobias
authors.initials: T
authors.lastname: Penzkofer
authors.forename: Kemal
authors.initials: K
authors.lastname: Tuncali
authors.forename: Andriy
authors.initials: A
authors.lastname: Fedorov
authors.forename: Sang-Eun
authors.initials: SE
authors.lastname: Song
authors.forename: Junichi
authors.initials: J
authors.lastname: Tokuda
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Fennessy
authors.forename: Mark G
authors.initials: MG
authors.lastname: Vangel
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.forename: Robert V
authors.initials: RV
authors.lastname: Mulkern
authors.forename: William M
authors.initials: WM
authors.lastname: Wells
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Hata
authors.forename: Clare M C
authors.initials: CM
authors.lastname: Tempany
mesh_terms: D000368:Aged; D003287:Contrast Media; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D061705:Image-Guided Biopsy; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010502:Perineum; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA