title: Detection of significant prostate cancer with magnetic resonance targeted biopsies--should transrectal ultrasound-magnetic resonance imaging fusion guided biopsies alone be a standard of care?
abstract: OBJECTIVE
  Magnetic resonance imaging-transrectal ultrasound fusion targeted prostate biopsies were suggested to detect significant cancer with more accuracy than systematic biopsies. In this study we evaluate the pathological characteristics of multiparametric magnetic resonance imaging detected and undetected tumor foci on radical prostatectomy specimens.
  
  
  METHODS
  We selected 125 consecutive patients treated with radical prostatectomy for clinically localized prostate cancer diagnosed on magnetic resonance imaging-transrectal ultrasound targeted biopsy and/or systematic biopsy. On multiparametric magnetic resonance imaging each suspicious area was graded according to the PI-RADS score. On radical prostatectomy specimen, tumor foci with a Gleason score greater than 3+3 and/or tumor volume greater than 0.5 ml were considered significant. A correlation analysis between multiparametric magnetic resonance imaging and pathological findings was performed.
  
  
  RESULTS
  Pathological analysis of radical prostatectomy specimens detected 230 tumor foci. Of these, 137 were considered significant (Gleason score greater than 3+3 in 112) and were observed in 111 (89%) glands. A total of 95 individual tumor foci, including 14 significant foci, were missed with multiparametric magnetic resonance imaging. All of them were located in glands where another focus was detected with multiparametric magnetic resonance imaging. An additional 9 individual tumor foci, including 7 significant, were detected on multiparametric magnetic resonance imaging but missed with targeted biopsy, resulting in 5 (4%) significant cancers undetected with magnetic resonance imaging-transrectal ultrasound fusion targeted biopsy. The magnetic resonance imaging target largest diameter was associated with high volume (greater than 0.5 cc) foci detection, while PI-RADS score and cancer involvement on targeted biopsy were associated with significant foci detection.
  
  
  CONCLUSIONS
  In these series of men with suspicious prostate multiparametric magnetic resonance imaging findings, magnetic resonance imaging-transrectal ultrasound fusion guided targeted biopsy alone strategy would have resulted in the under detection of only 4% significant cancers.
authors.affiliation: Department of Urology, Paris Descartes University, Paris, France. Electronic address: nicolasbdl@hotmail.com.
authors.forename: Nicolas Barry
authors.initials: NB
authors.lastname: Delongchamps
authors.affiliation: Department of Radiology, Paris Descartes University, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Lefèvre
authors.affiliation: Department of Clinical Research, Tarnier Hospital, Paris Descartes University, Paris, France.
authors.forename: Naïm
authors.initials: N
authors.lastname: Bouazza
authors.affiliation: Department of Pathology, Cochin Hospital, Paris Descartes University, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Beuvon
authors.affiliation: Department of Radiology, Paris Descartes University, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Legman
authors.affiliation: Department of Radiology, Paris Descartes University, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Cornud
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D012007:Rectum; D059039:Standard of Care; D018084:Ultrasonography, Interventional
keywords: biopsy; early detection of cancer; prostatic neoplasms