title: An initial negative round of targeted biopsies in men with highly suspicious multiparametric magnetic resonance findings does not exclude clinically significant prostate cancer-Preliminary experience.
abstract: Targeted prostate biopsies are changing the landscape of prostate cancer (PCa) diagnosis with the degree of suspicion on multiparametric magnetic resonance imaging (mpMRI) being a strong predictor of targeted biopsy outcome. Data regarding the rate and potential causes of false-negative magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion-targeted biopsy in patients with highly suspicious mpMRI findings are lacking.
  
  
  
  To determine the rate of clinically significant PCa detection in repeat targeted biopsy or surgery in patients with highly suspicious mpMRI findings and in an initial negative MRI-TRUS fusion-targeted biopsy.
  
  
  
  In this single-center, retrospective study of prospectively generated data, men with highly suspicious lesions (Likert 5 score) on mpMRI and an initial negative MRI-TRUS fusion-targeted biopsy were reviewed. The rate of PCa detection in a subsequent MRI-TRUS fusion-targeted biopsy or radical prostatectomy was determined. Tumors in the intermediate- and high-risk groups according to the National Comprehensive Cancer Network criteria were considered clinically significant.
  
  
  
  A total of 32 men with 38 Likert 5 lesions were identified. Repeat targeted biopsy or surgery detected cancer in 42% (16/38) of the Likert 5 lesions with initial negative targeted biopsy. Most of these cancers were intermediate- (69%; 11/16) or high-risk (25%; 4/16) tumors.
  
  
  
  A negative round of targeted biopsies does not exclude clinically significant PCa in men with highly suspicious mpMRI findings. Patients with imaging-pathology disagreement should be carefully reviewed and considered for repeat biopsy or for strict surveillance.
authors.affiliation: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX; Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: Daniel.Costa@UTSouthwestern.edu.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Costa
authors.affiliation: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Fernando U
authors.initials: FU
authors.lastname: Kay
authors.affiliation: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX; Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Ivan
authors.initials: I
authors.lastname: Pedrosa
authors.affiliation: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Lauren
authors.initials: L
authors.lastname: Kolski
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Claus G
authors.initials: CG
authors.lastname: Roehrborn
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Brad
authors.initials: B
authors.lastname: Hornberger
authors.affiliation: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Yin
authors.initials: Y
authors.lastname: Xi
authors.affiliation: Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Franto
authors.initials: F
authors.lastname: Francis
authors.affiliation: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX; Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Neil M
authors.initials: NM
authors.lastname: Rofsky
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*
keywords: Biopsy; Diagnosis; Early detection; Magnetic resonance imaging; Prostate cancer