title: [Multiparametric MRI and MRI-TRUS fusion biopsy in patients with prior negative prostate biopsy].
abstract: BACKGROUND
  Multiparametric MRI (mpMRI) plays an increasingly important role in prostate cancer (PCa) diagnostics and is recommended in men with previously negative TRUS biopsy. The optimal biopsy method after mpMRI is under discussion.
  
  
  OBJECTIVE
  Prospective, PIRADS- and START-conform analysis of the relevance of mpMRI and MRI-TRUS fusion biopsy in patients with prior negative TRUS biopsy and comparison of the detection rates of fusion-targeted biopsies (tB) and systematic transperineal saturation biopsies (sB).
  
  
  METHODS
  Between 10/2012 and 09/2015, 287 patients with prior negative TRUS biopsy underwent mpMRI and software-assisted, rigid MRI-TRUS fusion biopsy. In addition to and strictly separated from sB (median cores n = 24), tB (median cores per patient n = 4, per lesion n = 3) were performed in case of suspicious MRI lesions (PIRADS ≥ 2). Both biopsy methods were compared by using McNemar's test.
  
  
  RESULTS
  Of the 287 patients, 148 (52 %) had positive biopsies. Of these, 108/287 (38 %) had significant PCa (Gleason Score [GS] = 3 + 3 and PSA ≥ 10 ng/ml or GS ≥ 3 + 4) and again 43/287 (15 %) had a GS ≥ 4 + 3 PCa. sB failed to diagnose 8/148 PCa (5.4 %) and 6/108 significant PCa (5.5 %), whereas tB failed to diagnose 48 (32.4 %) PCa (p < 0.0001) and 22 (20.4 %) significant PCa (p = 0.0046). Of the PCa missed by tB, 11  had a GS ≥ 3 + 4 and 5 of these a GS = 4 + 3. On a per patient basis, MRI failed to detect 5 significant PCa, whereby 17 of the significant PCa were missed by fusion-targeted cores alone.
  
  
  CONCLUSIONS
  In men with unsuspicious MRI (PIRADS < 3), there is a 11 % risk of significant PCa. In case of suspicious MRI lesions, the combination of both biopsy approaches offers maximum tumor detection.
authors.affiliation: Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. Claudia.Kesch@med.uni-heidelberg.de.
authors.forename: C
authors.initials: C
authors.lastname: Kesch
authors.affiliation: Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.|Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland.
authors.forename: J P
authors.initials: JP
authors.lastname: Radtke
authors.affiliation: Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Distler
authors.affiliation: Universitätsklinik für Urologie, Universität Bern, Bern, Schweiz.
authors.forename: S
authors.initials: S
authors.lastname: Boxler
authors.affiliation: Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Klein
authors.affiliation: Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Hüttenbrink
authors.affiliation: Institut für Medizinische Biometrie und Informatik, Heidelberg, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Hees
authors.affiliation: Pathologisches Institut der Universität Heidelberg, Universität Heidelberg, Heidelberg, Deutschland.
authors.forename: W
authors.initials: W
authors.lastname: Roth
authors.affiliation: Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Roethke
authors.affiliation: Abteilung für Radiologie, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland.
authors.forename: H P
authors.initials: HP
authors.lastname: Schlemmer
authors.affiliation: Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Hohenfellner
authors.affiliation: Urologische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors.forename: B A
authors.initials: BA
authors.lastname: Hadaschik
mesh_terms: D000368:Aged; D005188:False Negative Reactions; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
keywords: Image fusion; Multiparametic magnetic resonance imaging; Prostate biopsy; Protstate cancer; Re-biopsy