title: Relationship Between Prebiopsy Multiparametric Magnetic Resonance Imaging (MRI), Biopsy Indication, and MRI-ultrasound Fusion-targeted Prostate Biopsy Outcomes.
abstract: BACKGROUND
  Increasing evidence supports the use of magnetic resonance imaging (MRI)-ultrasound fusion-targeted prostate biopsy (MRF-TB) to improve the detection of clinically significant prostate cancer (PCa) while limiting detection of indolent disease compared to systematic 12-core biopsy (SB).
  
  
  OBJECTIVE
  To compare MRF-TB and SB results and investigate the relationship between biopsy outcomes and prebiopsy MRI.
  
  
  METHODS
  Retrospective analysis of a prospectively acquired cohort of men presenting for prostate biopsy over a 26-mo period. A total of 601 of 803 consecutively eligible men were included.
  
  
  METHODS
  All men were offered prebiopsy MRI and assigned a maximum MRI suspicion score (mSS). Men with an MRI abnormality underwent combined MRF-TB and SB.
  
  
  RESULTS
  Detection rates for all PCa and high-grade PCa (Gleason score [GS] ≥7) were compared using the McNemar test.
  
  
  CONCLUSIONS
  MRF-TB detected fewer GS 6 PCas (75 vs 121; p<0.001) and more GS ≥7 PCas (158 vs 117; p<0.001) than SB. Higher mSS was associated with higher detection of GS ≥7 PCa (p<0.001) but was not correlated with detection of GS 6 PCa. Prediction of GS ≥7 disease by mSS varied according to biopsy history. Compared to SB, MRF-TB identified more GS ≥7 PCas in men with no prior biopsy (88 vs 72; p=0.012), in men with a prior negative biopsy (28 vs 16; p=0.010), and in men with a prior cancer diagnosis (42 vs 29; p=0.043). MRF-TB detected fewer GS 6 PCas in men with no prior biopsy (32 vs 60; p<0.001) and men with prior cancer (30 vs 46; p=0.034). Limitations include the retrospective design and the potential for selection bias given a referral population.
  
  
  CONCLUSIONS
  MRF-TB detects more high-grade PCas than SB while limiting detection of GS 6 PCa in men presenting for prostate biopsy. These findings suggest that prebiopsy multiparametric MRI and MRF-TB should be considered for all men undergoing prostate biopsy. In addition, mSS in conjunction with biopsy indications may ultimately help in identifying men at low risk of high-grade cancer for whom prostate biopsy may not be warranted.
  
  
  RESULTS
  We examined how magnetic resonance imaging (MRI)-targeted prostate biopsy compares to traditional systematic biopsy in detecting prostate cancer among men with suspicion of prostate cancer. We found that MRI-targeted biopsy detected more high-grade cancers than systematic biopsy, and that MRI performed before biopsy can predict the risk of high-grade cancer.
authors.affiliation: Department of Urology, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Xiaosong
authors.initials: X
authors.lastname: Meng
authors.affiliation: Department of Radiology, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Rosenkrantz
authors.affiliation: School of Medicine, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Mendhiratta
authors.affiliation: School of Medicine, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Fenstermaker
authors.affiliation: Department of Urology, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Huang
authors.affiliation: Department of Urology, NYU Langone Medical Center, New York, NY, USA; Department of Urology, New York Hospital Queens, Flushing, NY, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Wysock
authors.affiliation: Department of Urology, NYU Langone Medical Center, New York, NY, USA; Department of Urology, St. Barnabas Hospital, Bronx, NY, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Bjurlin
authors.affiliation: Department of Urology, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Marshall
authors.affiliation: Department of Pathology, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Fang-Ming
authors.initials: FM
authors.lastname: Deng
authors.affiliation: Department of Pathology, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhou
authors.affiliation: Department of Pathology, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Melamed
authors.affiliation: Department of Urology, NYU Langone Medical Center, New York, NY, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Huang
authors.affiliation: Department of Urology, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Herbert
authors.initials: H
authors.lastname: Lepor
authors.affiliation: Department of Urology, NYU Langone Medical Center, New York, NY, USA; Department of Radiology, NYU Langone Medical Center, New York, NY, USA. Electronic address: samir.taneja@nyumc.org.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Taneja
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D018084:Ultrasonography, Interventional
keywords: Magnetic resonance imaging-ultrasound fusion; Magnetic resonance imaging–targeted prostate biopsy; Prostate biopsy; Prostate cancer; Prostate magnetic resonance imaging