title: Multiparametric magnetic resonance imaging-transrectal ultrasound fusion-assisted biopsy for the diagnosis of local recurrence after radical prostatectomy.
abstract: OBJECTIVE
  Approximately 15% of patients who undergo radical prostatectomy (RP) for prostate cancer develop local recurrence, which is heralded by a rise in serum prostate-specific antigen (PSA) levels. Early detection and treatment of recurrence improves the outcome of salvage treatment. We investigated the ability of multiparametric magnetic resonance imaging (mpMRI)-transrectal ultrasound (TRUS) fusion-guided biopsy (FGB) combined with "cognitive biopsy" to confirm local recurrence of prostate cancer after RP.
  
  
  METHODS
  In this retrospective study conducted between January 2010 and December 2014, patients with rising PSA levels after RP who had no known evidence of distant metastases underwent mpMRI including T2-weighted (T2W) imaging, diffusion-weighted imaging, dynamic contrast-enhanced (DCE) MRI at 3 Tesla, and subsequent MRI-ultrasound fusion biopsy with cognitive assistance. The detection rate of locally recurrent disease was determined.
  
  
  RESULTS
  A total of 10 patients (mean age = 67y, mean PSA level = 3.44ng/ml) met the inclusion criteria. Of the 10 patients, all had positive findings suspicious for local recurrence on mpMRI per entrance criterion. The most important features on mpMRI were early enhancement on DCE MR images and hypointensity on T2W images. The average lesion diameter on mpMRI was 1.12cm (range: 0.40-2.20cm). All suspicious lesions (16/16, 100%) were positive on T2W MR images, 14 (89%) showed positive features on apparent diffusion coefficient maps of diffusion-weighted images, and 16 (100%) were positive on DCE MR images. MRI-TRUS FGBs were positive in 10/16 lesions (62.5%) and 8/10 (80%) patients.
  
  
  CONCLUSIONS
  MRI-TRUS FGB with cognitive assistance is able to detect and diagnose locally recurrent lesions after RP, even at low PSA levels. This may facilitate early detection of recurrent disease and improve salvage treatment outcomes.
authors.affiliation: Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Urology, AMC University Hospital, Amsterdam, the Netherlands.
authors.forename: Berrend G
authors.initials: BG
authors.lastname: Muller
authors.affiliation: Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Aradhana
authors.initials: A
authors.lastname: Kaushal
authors.affiliation: Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sankineni
authors.affiliation: Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Elena
authors.initials: E
authors.lastname: Lita
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Hoang
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Arvin K
authors.initials: AK
authors.lastname: George
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.affiliation: Philips Research North America, Briarcliff Manor, NY.
authors.forename: Jochen
authors.initials: J
authors.lastname: Kruecker
authors.affiliation: Philips Research North America, Briarcliff Manor, NY.
authors.forename: Pingkun
authors.initials: P
authors.lastname: Yan
authors.affiliation: Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Sheng
authors.initials: S
authors.lastname: Xu
authors.affiliation: Department of Urology, AMC University Hospital, Amsterdam, the Netherlands.
authors.forename: Jean J
authors.initials: JJ
authors.lastname: de la Rosette
authors.affiliation: Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Merino
authors.affiliation: Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Wood
authors.affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
authors.affiliation: Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Choyke
authors.affiliation: Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD. Electronic address: turkbeyi@mail.nih.gov.
authors.forename: Baris
authors.initials: B
authors.lastname: Turkbey
mesh_terms: D000368:Aged; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D017430:Prostate-Specific Antigen
keywords: Biochemical recurrence; MRI; MRI-ultrasound fusion–guided biopsy; Prostate cancer