title: Direct comparison of targeted MRI-guided biopsy with systematic transrectal ultrasound-guided biopsy in patients with previous negative prostate biopsies.
abstract: OBJECTIVE
  To directly compare the diagnostic performance of targeted MRI-guided biopsy (MR-GB) and systematic transrectal ultrasound-guided biopsy (TRUS-GB).
  
  
  METHODS
  Thirty-five patients with at least one negative TRUS-GB, persistently elevated or rising prostate-specific antigen and a lesion suspicious for prostate cancer (PC) on multiparametric MRI (mpMRI) scored by using the Prostate Imaging Reporting and Data System (PI-RADS) were included. A median of three targeted biopsies per lesion were obtained and systematic TRUS-GB was performed subsequently by an independent urologist without knowledge of the MRI findings. Definite pathology reports were analyzed for anatomical location and criteria of clinical significance.
  
  
  RESULTS
  The tumor detection rate was significantly higher with MR-GB compared with TRUS-GB (16/35, 46% and 8/35, 23%, respectively, p < 0.05). MR-GB detected PC in all patients with positive TRUS-GB. All tumors detected by MR-GB exhibited at least one criterion of clinical significance. PC lesions showed a significantly higher PI-RADS sum score compared with benign lesions.
  
  
  CONCLUSIONS
  MR-GB is more effective compared with TRUS-GB in detecting clinically significant PC in men after previous negative TRUS-GB. PI-RADS scores give additional information and could be part of the decision-making process when considering retrial biopsy. Additional systematic biopsy can be omitted in patients undergoing targeted MR-GB.
authors.affiliation: Department of Radiology, Comprehensive Cancer Center (CCC) Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Kaufmann
authors.forename: Stephan
authors.initials: S
authors.lastname: Kruck
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kramer
authors.forename: Sergios
authors.initials: S
authors.lastname: Gatidis
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Matthias
authors.initials: M
authors.lastname: Roethke
authors.forename: Marcus
authors.initials: M
authors.lastname: Scharpf
authors.forename: David
authors.initials: D
authors.lastname: Schilling
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods*; D016208:Databases, Factual; D005188:False Negative Reactions; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D012720:Severity of Illness Index; D014463:Ultrasonography