title: Combined T2 and diffusion-weighted MR imaging with template prostate biopsies in men suspected with prostate cancer but negative transrectal ultrasound-guided biopsies.
abstract: OBJECTIVE
  Transperineal template prostate (TPB) biopsy has been shown to improve prostate cancer detection in men with rising PSA and previous negative TRUS biopsies. Diagnostic performance of this approach especially MR imaging and using reliable reference standard remains scantly reported.
  
  
  METHODS
  A total of 200 patients, who were previously TRUS biopsy negative, were recruited in this study. All the participants had at least 28-core TPB under general anesthetic within 8 weeks of previous negative TRUS biopsies. In 15 men undergoing laparoscopic radical prostatectomy, prostate specimens were sectioned using custom-made molds and analyzed by experienced pathologist as a feasibility study.
  
  
  RESULTS
  In total, 120 of 200 patients (60 %) had positive TPB biopsy results. All of these men had at least one negative biopsy from transrectal route. T2 diffusion-weighted MR imaging showed no lesion in almost one-third of these men (61/200; 30.5 %). Out of these, 33 (33/61; 54 %) showed malignancy on TPB including high-grade tumors (>Gleason 7). Out of 15 patients underwent surgery with a total of 52 lesions (mean 3.5) on radical prostatectomy histology analyses, TPB detected 36 (70 %) lesions only. Some of these lesions were Gleason 7 and more mostly located in the posterior basal area of prostate.
  
  
  CONCLUSIONS
  Transperineal template biopsy technique is associated with significantly high prostate cancer detection rate in men with previous negative TRUS biopsies, however compared to radical prostatectomy histology map, a significant number of lesions can still be missed in the posterior and basal area of prostate.
authors.affiliation: Department of Urology, Pilgrim Hospital, United Lincolnshire NHS Trust, England, UK.
authors.forename: Nissar
authors.initials: N
authors.lastname: Sheikh
authors.affiliation: Division of Cancer Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
authors.forename: Cheng
authors.initials: C
authors.lastname: Wei
authors.affiliation: Division of Cancer Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.|Department of Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Szewczyk-Bieda
authors.affiliation: Technology & Innovation in Learning Team (TILT), School of Medicine, University of Dundee, Dundee, DD1 9SY, UK.
authors.forename: Annie
authors.initials: A
authors.lastname: Campbell
authors.affiliation: Department of Urology, Pilgrim Hospital, United Lincolnshire NHS Trust, England, UK.
authors.forename: Shaukat
authors.initials: S
authors.lastname: Memon
authors.affiliation: Department of Pathology, Ninewells Hospital, Dundee, DD1 9SY, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lang
authors.affiliation: Division of Cancer Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK. g.nabi@dundee.ac.uk.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Nabi
mesh_terms: D000368:Aged; D003663:Decision Trees; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D061705:Image-Guided Biopsy; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D018084:Ultrasonography, Interventional
keywords: Diffusion-weighted imaging (DWI); Multiparametric MRI (mpMRI); Prostate cancer (PCa); T2-weighted image (T2WI); Transperineal template biopsy (TPB); Transrectal ultrasound (TRUS)