title: [Real-time MRI/US fusion-guided biopsy in biopsy-naïve and pre-biopsied patients with suspicion for prostate cancer].
abstract: BACKGROUND
  Magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy detects more prostate cancer (PCa) than transrectal US (TRUS)-guided biopsy in patients with an indication for prostate re-biopsy. The aim of this study was a) to compare the detection rates of MRI/US fusion-guided biopsy with conventional TRUS in a double centre cohort and b) to investigate the influence of the number of pre-biopsies on the PCa detection rate.
  
  
  METHODS
  In the period from January 2012 to July 2014, 310 consecutive patients gave written informed consent and underwent 3 Tesla MRI scans of the prostate. All patients had at least one PCa suspicious lesion in the MRI and were biopsied by MRI/US fusion followed by a conventional 10-core biopsy of the prostate. Detection rates based on technique, Gleason score and number of pre-biopsies were calculated.
  
  
  RESULTS
  The overall detection rate of the study was 51% (158 patients). Among these 158 patients a histopathological Gleason score of 6 was detected in 60 patients (38%), a Gleason score of 7 in 54 patients (34%) and a Gleason score≥8 in 44 patients (28%). MRI/US fusion-guided biopsy detected 110 (69.7%) of the overall detected 158 PCa. TRUS-guided biopsy detected a higher rate of Gleason score 6 (54%) and a lower rate of Gleason score≥8 (15%) lesions in comparison to 38% Gleason 6 and 28% Gleason≥8 in the MRI/US fusion-guided biopsy, respectively. Furthermore, a lower Gleason score was observed in patients with more than one pre-biopsy. The detection rate in biopsy-naïve patients undergoing MRI/US fusion was 75% (40 patients) among 75% detected Gleason score≥7.
  
  
  CONCLUSIONS
  MRI/US fusion-guided biopsy detected more PCa and also more clinically significant cancer than conventional TRUS. In our cohort patients with more than one pre-biopsy showed lower Gleason scores. The included patients with an initial MRI/US fusion-guided biopsy should be further investigated.
authors.affiliation: Klinik für Urologie, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: A
authors.initials: A
authors.lastname: Maxeiner
authors.affiliation: Klinik für Urologie, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: C
authors.initials: C
authors.lastname: Stephan
authors.affiliation: Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: T
authors.initials: T
authors.lastname: Fischer
authors.affiliation: Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: T
authors.initials: T
authors.lastname: Durmus
authors.affiliation: Klinik für Pathologie, Charité - Universitätsmedizin Berlin, CCM, Berlin.
authors.forename: E
authors.initials: E
authors.lastname: Kilic
authors.affiliation: Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: P
authors.initials: P
authors.lastname: Asbach
authors.affiliation: Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: M
authors.initials: M
authors.lastname: Haas
authors.affiliation: Klinik für Urologie, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: K
authors.initials: K
authors.lastname: Günzel
authors.affiliation: Klinik für Urologie, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: J
authors.initials: J
authors.lastname: Neymeyer
authors.affiliation: Klinik für Urologie, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: K
authors.initials: K
authors.lastname: Miller
authors.affiliation: Klinik für Urologie, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: H
authors.initials: H
authors.lastname: Cash
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D060787:Neoplasm Grading; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000473:pathology*; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*