title: Multiparametric magnetic resonance imaging-targeted biopsy for the detection of prostate cancer in patients with prior negative biopsy results.
abstract: OBJECTIVE
  We aimed to determine the performance of multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer (PCa) in patients with prior negative transrectal ultrasound-guided prostate biopsy (TRUS-B) results.
  
  
  METHODS
  Between 2010 and 2013, 2,416 men underwent TRUS-B or an mpMRI or both at Vancouver General Hospital. Among these, 283 men had persistent suspicion of PCa despite prior negative TRUS-B finding. An MRI was obtained in 112, and a lesion (prostate imaging reporting and data system score ≥ 3) was identified in 88 cases (78%). A subsequent combined MRI-targeted and standard template biopsy was performed in 86 cases. A matching cohort of 86 patients was selected using a one-nearest neighbor method without replacement. The end points were the rate of diagnosis of PCa and significant PCa (sPCa) (Gleason > 6, or > 2 cores, or > 50% of any core).
  
  
  RESULTS
  MRI-targeted TRUS-B detected PCa and sPCa in 36 (41.9%) and 30 (34.9%) men when compared with 19 (22.1%) and 14 (16.3%), respectively, men without mpMRI (P = 0.005 for both). In 9 cases (10.4%), MRI-targeted TRUS-B detected sPCa that was missed on standard cores. sPCa was present in 6 cases (6.9%) on standard cores but not the targeted cores. Multivariate analysis revealed that prostate imaging reporting and data system score and prostate-specific antigen density > 0.15 ng/ml(2) were statistically significant predictors of significant cancer detection (odds ratio = 14.93, P < 0.001 and odds ratio = 6.19, P = 0.02, respectively).
  
  
  CONCLUSIONS
  In patients with prior negative TRUS-B finding, MRI-targeted TRUS-B improves the detection rate of all PCa and sPCa.
authors: Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
authors: Hamidreza
authors: H
authors: Abdi
authors: Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
authors: Homayoun
authors: H
authors: Zargar
authors: Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
authors: S Larry
authors: SL
authors: Goldenberg
authors: Department of Radiology, University of British Columbia, Vancouver, Canada.
authors: Triona
authors: T
authors: Walshe
authors: Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
authors: Farshad
authors: F
authors: Pourmalek
authors: Department of Radiology, University of British Columbia, Vancouver, Canada.
authors: Christopher
authors: C
authors: Eddy
authors: Department of Radiology, University of British Columbia, Vancouver, Canada.
authors: Silvia D
authors: SD
authors: Chang
authors: Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
authors: Martin E
authors: ME
authors: Gleave
authors: Department of Radiology, University of British Columbia, Vancouver, Canada.
authors: Alison C
authors: AC
authors: Harris
authors: Department of Radiology, University of British Columbia, Vancouver, Canada.
authors: Alan I
authors: AI
authors: So
authors: Department of Radiology, University of British Columbia, Vancouver, Canada.
authors: Lindsay
authors: L
authors: Machan
authors: Department of Urologic Sciences, University of British Columbia, Vancouver, Canada. Electronic address: pblack@mail.ubc.ca.
authors: Peter C
authors: PC
authors: Black
mesh_terms: D000368:Aged; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Image-guided biopsy; Magnetic resonance imaging; Prostate; Prostatic neoplasms; Targeted biopsy; Ultrasonography