title: The detection of significant prostate cancer is correlated with the Prostate Imaging Reporting and Data System (PI-RADS) in MRI/transrectal ultrasound fusion biopsy.
abstract: OBJECTIVE
  To evaluate the performance of real-time MRI/ultrasound (MRI/US) fusion-guided targeted biopsy (TB) in men with primary and repeat biopsies and correlate the prostate cancer detection rate (CDR) with the PI-RADS score.
  
  
  METHODS
  Analysis included 408 consecutive men with primary and prior negative biopsies who underwent TB and 10-core random biopsy (RB) between January 2012 and January 2015. TB was performed with a real-time MRI/US fusion platform with sensor-based registration. Clinically significant PCa was defined as Gleason score (GS) ≥ 7 or GS 6 with maximal cancer core length ≥ 4 mm for TB and according to Epstein criteria for RB.
  
  
  RESULTS
  The overall CDR was 56 % (227/408). The CDR for primary biopsy was 74 % (60/81) and 57 % (67/117), 49 % (62/126), 45 % (38/84) for patients with 1, 2 and ≥ 3 prior negative biopsies. CDRs correlated with PI-RADS 2/3/4/5 were 16 % (5/32), 26 % (29/113), 62 % (94/152) and 89 % (99/111), respectively. The rates of significant tumors in relation to PI-RADS 2/3/4/5 were 60 % (3/5), 66 % (19/29), 74 % (70/94), 95 % (94/99). In 139 (61 %) cases with radical prostatectomy (RP), the rates of ≥ pT3 tumors in correlation with PI-RADS 4 and 5 were 20 % (11/56) and 49 % (32/65). PI-RADS constituted the strongest predictor of significant PCa detection (p < 0.007).
  
  
  CONCLUSIONS
  Real-time MRI/US fusion-guided TB combined with RB improved PCa detection in patients with primary and repeat biopsies. The CDR was strongly correlated with a rising PI-RADS score, values of 4 and 5 increasing the detection of clinically significant tumors and leading to a higher histological stage after RP.
authors: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany. hannes.cash@charite.de.
authors: Hannes
authors: H
authors: Cash
authors: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors: Andreas
authors: A
authors: Maxeiner
authors: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors: Carsten
authors: C
authors: Stephan
authors: Department of Radiology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors: Thomas
authors: T
authors: Fischer
authors: Department of Radiology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors: Tahir
authors: T
authors: Durmus
authors: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors: Josephine
authors: J
authors: Holzmann
authors: Department of Radiology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors: Patrick
authors: P
authors: Asbach
authors: Department of Radiology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors: Matthias
authors: M
authors: Haas
authors: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors: Stefan
authors: S
authors: Hinz
authors: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors: Jörg
authors: J
authors: Neymeyer
authors: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors: Kurt
authors: K
authors: Miller
authors: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors: Karsten
authors: K
authors: Günzel
authors: Department of Urology, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors: Carsten
authors: C
authors: Kempkensteffen
mesh_terms: D000368:Aged; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012007:Rectum; D015203:Reproducibility of Results; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: PI-RADS; Prostate biopsy; Prostate cancer/diagnosis; Real-time MRI/ultrasound fusion biopsy; Targeted biopsy