title: Cognitive MRI-TRUS fusion-targeted prostate biopsy according to PI-RADS classification in patients with prior negative systematic biopsy results.
abstract: BACKGROUND
  The purpose of this study was to evaluate the prostate cancer yield rate of targeted transrectal ultrasound (TRUS)-guided biopsy with cognitive magnetic resonance imaging (MRI) registration without concurrent systematic biopsy in patients with previous negative systematic TRUS-guided biopsy results and persistently elevated prostate-specific antigen (PSA) levels.
  
  
  METHODS
  In this prospective study conducted from August 2013 to January 2015, patients with at least one previous negative systematic TRUS-guided biopsy and persistently high PSA (≥4 ng/mL) levels were referred for multiparametric MRI (mpMRI). Those patients with suspicious findings on mpMRI received a subsequent cognitive MRI-TRUS fusion biopsy. The cancer-detection rate, tumor location, and Gleason score were confirmed, and PSA-related data were compared between cancer-yield and noncancer-yield groups.
  
  
  RESULTS
  In total, 48 patients were included in this study. MRI was designated to be four and five in 17 patients. Fifteen patients received a cognitive fusion-targeted biopsy, and prostate cancers were detected in 10 patients. The cancer-detection rate was 20.8% (10/48), and the positive-predictive value of MRI was 66.7%. No significant differences were observed in the PSA level, PSA velocity, or transitional zone volume between the cancer-yield and noncancer-yield groups; however, the corresponding difference in PSA transitional zone density was significant (p=0.025).
  
  
  CONCLUSIONS
  Cognitive MRI-TRUS fusion-targeted biopsy without concurrent systematic biopsy can detect significant prostate cancer in patients with previous negative systematic biopsy results and persistently elevated PSA levels. Noncancer-yield patients should undergo active surveillance and further follow-ups.
authors: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors: Wei-Jen
authors: WJ
authors: Lai
authors: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors: Hsin-Kai
authors: HK
authors: Wang
authors: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors: Hsian-Tzu
authors: HT
authors: Liu
authors: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: Byung Kwan
authors: BK
authors: Park
authors: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; National Yang-Ming University, Institute of Public Health, Taipei, Taiwan, ROC. Electronic address: shshen@vghtpe.gov.tw.
authors: Shu-Huei
authors: SH
authors: Shen
authors: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors: Tzu-Ping
authors: TP
authors: Lin
authors: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors: Hsiao-Jen
authors: HJ
authors: Chung
authors: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors: Yi-Hsiu
authors: YH
authors: Huang
authors: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors: Yen-Hwa
authors: YH
authors: Chang
mesh_terms: D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000145:classification / Q000473:pathology*; D018084:Ultrasonography, Interventional
chemical_list: D017430:Prostate-Specific Antigen
keywords: image-guided biopsy; magnetic resonance imaging; prostate; prostate cancer; prostate-specific antigen