In-bore magnetic resonance-guided transrectal biopsy for the detection of clinically significant prostate cancer.
To determine the safety and efficacy of in-bore magnetic resonance-guided prostate biopsy (MRGB) for detection of clinically significant disease (CSD) in untreated men with known or suspected prostate cancer (PCa).



512 patients underwent multiparametric magnetic resonance imaging (Mp-MRI) followed by MRGB at one of three centers in this IRB-approved, HIPAA-compliant, retrospective study. Exclusion criteria were prior prostate cancer therapy and incomplete Mp-MRI (n = 51). Patients (n = 461) were analyzed in two subcohorts: no prior PCa (NP) (n = 381) and active surveillance (AS) (n = 80). Detection rates of PCa and CSD (Gleason Score ≥3 + 4) were calculated and compared among subcohorts and by Mp-MRI assessment grade. Logistic regression was performed to identify predictors for detection of PCa and CSD.



Mean patient age was 66 years, median prostate-specific antigen (PSA) was 7.5 ng/mL, and median prostate volume was 54 cc. A mean of 1.7 targets was sampled per gland. Significant adverse events (urosepsis and hematuria with obstruction) occurred in 1% (5/461). Overall PCa detection rates were 51% per patient (233/461) and 37% per lesion (282/757). 65% (151/233) of men with detected PCa had CSD. Per-patient PCa detection rates in the NP and AS subcohorts were 47% (178/381) and 69% (55/80), respectively, significantly higher in the AS group (p < 0.001). CSD was detected in 10% (47/451), 43% (96/225) and 84% (68/81) of lesions with Mp-MRI assessment grades of 3, 4, and 5, respectively. Older age, higher PSA, and lower prostate volume predicted MRGB detection of CSD (OR 1.07 and p = 0.003, OR 1.1 and p = 0.014, and OR 0.98 and p = 0.032, respectively).



In-bore MRGB is safe and high yield for detection of CSD.
Department of Radiology, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza Suite 1638, Los Angeles, CA, 90095, USA. efelker@mednet.ucla.edu.
Ely R
ER
Felker
Department of Radiology, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza Suite 1638, Los Angeles, CA, 90095, USA.
Stephanie A
SA
Lee-Felker
Desert Medical Imaging, 1133 N Palm Canyon Dr. Suite B, Palm Springs, CA, 92262, USA.
John
J
Feller
Department of Radiology, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza Suite 1638, Los Angeles, CA, 90095, USA.
Daniel J
DJ
Margolis
Department of Radiology, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza Suite 1638, Los Angeles, CA, 90095, USA.
David S
DS
Lu
Rolling Oaks Radiology, 415 Rolling Oaks Dr., Thousand Oaks, CA, 91361, USA.
Robert
R
Princenthal
Desert Medical Imaging, 1133 N Palm Canyon Dr. Suite B, Palm Springs, CA, 92262, USA.
Stuart
S
May
Rolling Oaks Radiology, 415 Rolling Oaks Dr., Thousand Oaks, CA, 91361, USA.
Martin
M
Cohen
Department of Pathology, David Geffen School of Medicine, 10833 Le Conte Ave., Suite 13-229 CHS, Los Angeles, CA, 90095, USA.
Jiaoti
J
Huang
Newport Urologic Oncology, 1525 Superior Avenue #210, Newport Beach, CA, 92663, USA.
Jeffrey
J
Yoshida
Desert Medical Imaging, 1133 N Palm Canyon Dr. Suite B, Palm Springs, CA, 92262, USA.
Bernadette
B
Greenwood
Department of Radiology, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza Suite 1638, Los Angeles, CA, 90095, USA.
Hyun J
HJ
Kim
Department of Radiology, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza Suite 1638, Los Angeles, CA, 90095, USA.
Steven S
SS
Raman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D006801:Humans; D061705:Image-Guided Biopsy; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D047368:Tumor Burden
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
Active surveillance; MRI-Guided biopsy; Prostate cancer