Preoperative prostate biopsy and multiparametric magnetic resonance imaging: reliability in detecting prostate cancer.
OBJECTIVE
The aim of the study was to analyse and compare the ability of multiparametric magnetic resonance imaging (mp-MRI) and prostate biopsy (PB) to correctly identify tumor foci in patients undergoing radical prostatectomy (RP) for prostate cancer (PCa).


METHODS
157 patients with clinically localised PCa with a PSA <10 ng/ mL and a negative DRE diagnosed on the first (12 samples, Group A) or second (18 samples, Group B) PB were enrolled at our institution. All patients underwent mp-MRI with T2-weighted images, diffusion-weighted imaging, dynamic contrast enhanced-MRI prior to RP. A map of comparison describing each positive biopsy sample was created for each patient, with each tumor focus shown on the MRI and each lesion present on the definitive histological examination in order to compare tumor detection and location. The sensitivity of mp-MRI and PB for diagnosis was compared using Student's t-test. The ability of the two exams to detect the prevalence of Gleason pattern 4 in the identified lesions was compared using a chi-square test.


RESULTS
Overall sensitivity of PB and mp-MRI to identify tumor lesion was 59.4% and 78.9%, respectively (p<0.0001). PB missed 144/355 lesions, 59 of which (16.6%) were significant. mp-MRI missed 75/355 lesions, 12 of which (3.4%) were significant. No lesions with a GS≥8 were missed. Sensitivity of PB and mp-MRI to detect the prevalence of Gleason pattern 4 was 88.2% and 97.4%, respectively.


CONCLUSIONS
mp-MRI seems to identify more tumor lesions than PB and to provide more information concerning tumor characteristics.
Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
Francesco
F
Porpiglia
Radiology Unit Institute for Cancer Research and Treatment, Candiolo, Turin, Italy.
Filippo
F
Russo
Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
Matteo
M
Manfredi
Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
Fabrizio
F
Mele
Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
Cristian
C
Fiori
Radiology Unit Institute for Cancer Research and Treatment, Candiolo, Turin, Italy.
Daniele
D
Regge
D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D060787:Neoplasm Grading; D057234:Preoperative Period; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D047368:Tumor Burden
D017430:Prostate-Specific Antigen