title: Presence of Magnetic Resonance Imaging Suspicious Lesion Predicts Gleason 7 or Greater Prostate Cancer in Biopsy-Naive Patients.
abstract: OBJECTIVE
  To compare the relative value of magnetic resonance imaging (MRI) in biopsy-naive patients to those with previous negative biopsy. Although MRI-targeted biopsy has been studied in several major prostate cancer (PCa) cohorts (biopsy naive, previous negative biopsy, and active surveillance), the relative benefit in these cohorts has not been established.
  
  
  METHODS
  We retrospectively reviewed biopsy-naive (n = 45) and previous negative biopsy (n = 55) patients who underwent prostate MRI prior to biopsy at our institution. Patients with an MRI suspicious region (MSR) underwent MRI-targeted biopsy as well as a systematic template biopsy, whereas those without MSR underwent only the template biopsy. All biopsies were performed with the TargetScan (Envisioneering, Pittsburgh, PA) biopsy system. MRI targeting was performed with cognitive guidance.
  
  
  RESULTS
  On multivariate logistic regression, the presence of an MSR was the only statistically significant and independent predictor of Gleason ≥ 7 PCa on biopsy for biopsy-naive men (odds ratio [OR] 40.2, P = .01). For men with previous negative biopsy, the presence of MSR was not a predictor of Gleason ≥ 7 PCa on biopsy (OR 4.35, P = .16), whereas PSA density > 0.15 ng/mL(2) was a significant and independent predictor (OR 66.2, P < .01).
  
  
  CONCLUSIONS
  Prostate MRI should be considered prior to biopsy in all patients presenting with clinical suspicion for PCa, as presence of a MSR will help guide prebiopsy counseling and provide an opportunity for MRI targeting during biopsy.
authors.affiliation: Division of Urology, Washington University School of Medicine, St. Louis, MO.
authors.forename: John K
authors.initials: JK
authors.lastname: Weaver
authors.affiliation: Division of Urology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Division of Urology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Vetter
authors.affiliation: Department of Radiology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Fowler
authors.affiliation: Department of Radiology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Cary L
authors.initials: CL
authors.lastname: Siegel
authors.affiliation: Division of Urology, Washington University School of Medicine, St. Louis, MO. Electronic address: uropro2012@gmail.com.
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Andriole
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies