title: Magnetic resonance imaging-directed transperineal limited-mapping prostatic biopsies to diagnose prostate cancer: a Scottish experience.
abstract: BACKGROUND
  Transperineal prostatic biopsy is firmly established as an important tool in the diagnosis of prostate cancer. The benefit of additional imaging (magnetic resonance imaging) to target biopsy remains to be fully addressed.
  
  
  METHODS
  Using a cohort of consecutive patients undergoing transperineal template mapping biopsies, we studied positive biopsies in the context of magnetic resonance imaging findings and examined the accuracy of magnetic resonance imaging in predicting the location of transperineal template mapping biopsies-detected prostate cancer.
  
  
  RESULTS
  Forty-four patients (mean age: 65 years, range 53-78) underwent transperineal template mapping biopsies. Thirty-four patients had 1-2 and 10 patients had ≥3 previous transrectal ultrasound scan-guided biopsies. The mean prostate-specific antigen was 15 ng/mL (range 2.5-79 ng/mL). High-grade prostatic intraepithelial neoplasia was found in 12 (27%) patients and prostate cancer with Gleason <7, 7 and >7 in 13, 10 and 8 patients, respectively. Suspicious lesions on magnetic resonance imaging scans were scored from 1 to 5. In 28 patients, magnetic resonance imaging detected lesions with score ≥3. Magnetic resonance imaging correctly localised transperineal template mapping biopsies-detected prostate cancer in a hemi-gland approach, particularly in a right to left manner (79% positive prediction rate), but not in a quadrant approach (33% positive prediction rate).
  
  
  CONCLUSIONS
  Our findings support the notion of magnetic resonance imaging-based selection of patients for transperineal template mapping biopsies and that lesions revealed by magnetic resonance imaging are likely useful for targeted biopsies.
authors.affiliation: Core Surgical Trainee, Department of Urology, NHS Greater Glasgow and Clyde, UK.
authors.forename: Ankur
authors.initials: A
authors.lastname: Mukherjee
authors.affiliation: Clinical Fellow, Department of Urology, NHS Greater Glasgow and Clyde, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Morton
authors.affiliation: Consultant Pathologist, Department of Pathology, NHS Greater Glasgow and Clyde, UK.
authors.forename: Sioban
authors.initials: S
authors.lastname: Fraser
authors.affiliation: Consultant Pathologist, Department of Pathology, NHS Greater Glasgow and Clyde, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Salmond
authors.affiliation: Consultant Radiologist, Department of Radiology, NHS Greater Glasgow and Clyde, UK.
authors.forename: Grant
authors.initials: G
authors.lastname: Baxter
authors.affiliation: Professor of Urology/Consultant Urologist, Department of Urology, NHS Greater Glasgow and Clyde, UK; Beatson Institute for Cancer Research, UK; Institute of Cancer Sciences, University of Glasgow, UK h.leung@beatson.gla.ac.uk.
authors.forename: Hing Y
authors.initials: HY
authors.lastname: Leung
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D006801:Humans; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010502:Perineum; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D015203:Reproducibility of Results; D012606:Scotland / Q000453:epidemiology; D018084:Ultrasonography, Interventional
keywords: Magnetic resonance imaging; prostate cancer; transperineal mapping prostatic biopsies