title: Improved detection of anterior fibromuscular stroma and transition zone prostate cancer using biparametric and multiparametric MRI with MRI-targeted biopsy and MRI-US fusion guidance.
abstract: BACKGROUND
  The objective of this study was to analyze the potential of prostate magnetic resonance imaging (MRI) and MRI/transrectal ultrasound-fusion biopsies to detect and to characterize significant prostate cancer (sPC) in the anterior fibromuscular stroma (AFMS) and in the transition zone (TZ) of the prostate and to assess the accuracy of multiparametric MRI (mpMRI) and biparametric MRI (bpMRI) (T2w and diffusion-weighted imaging (DWI)).
  
  
  METHODS
  Seven hundred and fifty-five consecutive patients underwent prebiopsy 3 T mpMRI and transperineal biopsy between October 2012 and September 2014. MRI images were analyzed using PIRADS (Prostate Imaging-Reporting and Data System). All patients had systematic biopsies (SBs, median n=24) as reference test and targeted biopsies (TBs) with rigid software registration in case of MRI-suspicious lesions. Detection rates of SBs and TBs were assessed for all PC and sPC patients defined by Gleason score (GS)⩾3+4 and GS⩾4+3. For PC, which were not concordantly detected by TBs and SBs, prostatectomy specimens were assessed. We further compared bpMRI with mpMRI.
  
  
  RESULTS
  One hundred and ninety-one patients harbored 194 lesions in AFMS and TZ on mpMRI. Patient-based analysis detected no difference in the detection of all PC for SBs vs TBs in the overall cohort, but in the repeat-biopsy population TBs performed significantly better compared with SBs (P=0.004 for GS⩾3+4 and P=0.022 for GS⩾4+3, respectively). Nine GS⩾4+3 sPCs were overlooked by SBs, whereas TBs missed two sPC in men undergoing primary biopsy. The combination of SBs and TBs provided optimal local staging. Non-inferiority analysis showed no relevant difference of bpMRI to mpMRI in sPC detection.
  
  
  CONCLUSIONS
  MRI-targeted biopsies detected significantly more anteriorly located sPC compared with SBs in the repeat-biopsy setting. The more cost-efficient bpMRI was statistically not inferior to mpMRI in sPC detection in TZ/AFMS.
authors.affiliation: 1] Department of Urology, University Hospital Heidelberg, Heidelberg, Germany [2] Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: J P
authors.initials: JP
authors.lastname: Radtke
authors.affiliation: Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Boxler
authors.affiliation: Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: T H
authors.initials: TH
authors.lastname: Kuru
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: M B
authors.initials: MB
authors.lastname: Wolf
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: C D
authors.initials: CD
authors.lastname: Alt
authors.affiliation: Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: I V
authors.initials: IV
authors.lastname: Popeneciu
authors.affiliation: Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Steinemann
authors.affiliation: Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Huettenbrink
authors.affiliation: Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Bergstraesser-Gasch
authors.affiliation: Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Klein
authors.affiliation: Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kesch
authors.affiliation: Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Roethke
authors.affiliation: Clinical Cancer Registry, National Center of Tumour Diseases, German Cancer Research Center, Heidelberg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Becker
authors.affiliation: Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Roth
authors.affiliation: Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: H-P
authors.initials: HP
authors.lastname: Schlemmer
authors.affiliation: Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hohenfellner
authors.affiliation: Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: B A
authors.initials: BA
authors.lastname: Hadaschik
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D047368:Tumor Burden
chemical_list: D017430:Prostate-Specific Antigen