title: MRI-directed cognitive fusion-guided biopsy of the anterior prostate tumors.
abstract: OBJECTIVE
  We aimed to evaluate the efficacy of magnetic resonance imaging (MRI)-directed cognitive fusion transrectal ultrasonography (TRUS)-guided anterior prostate biopsy for diagnosis of anterior prostate tumors and to illustrate this technique.
  
  
  METHODS
  A total of 39 patients with previous negative TRUS biopsy, but high clinical suspicion of occult prostate cancer, prospectively underwent prostate MRI including diffusion-weighted imaging (DWI). Patients with a suspicious anterior lesion on MRI underwent targeted anterior gland TRUS-guided biopsy with cognitive fusion technique using sagittal probe orientation. PIRADS version 1 scores (T2, DWI, and overall), lesion size, prostate-specific antigen (PSA), PSA density, and prostate gland volume were compared between positive and negative biopsy groups and between clinically significant cancer and remaining cases. Logistic regression analysis of imaging parameters and prostate cancer diagnosis was performed.
  
  
  RESULTS
  Anterior gland prostate adenocarcinoma was diagnosed in 18 patients (46.2%) on targeted anterior gland TRUS-guided biopsy. Clinically significant prostate cancer was diagnosed in 13 patients (33.3%). MRI lesion size, T2, DWI, and overall PIRADS scores were significantly higher in patients with positive targeted biopsies and those with clinically significant cancer (P < 0.05). Biopsies were positive in 90%, 33%, and 29% of patients with overall PIRADS scores of 5, 4, and 3 respectively. Overall PIRADS score was an independent predictor of all prostate cancer diagnosis and of clinically significant prostate cancer diagnosis.
  
  
  CONCLUSIONS
  Targeted anterior gland TRUS-guided biopsy with MRI-directed cognitive fusion enables accurate sampling and may improve tumor detection yield of anterior prostate cancer.
authors.affiliation: Department of Radiology, St. Vincent's University Hospital, Dublin Ireland. colmjmcmahon@yahoo.co.uk.
authors.forename: Ian G
authors.initials: IG
authors.lastname: Murphy
authors.forename: Elaine
authors.initials: E
authors.lastname: NiMhurchu
authors.forename: Robert G
authors.initials: RG
authors.lastname: Gibney
authors.forename: Colm J
authors.initials: CJ
authors.lastname: McMahon
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D006801:Humans; D061705:Image-Guided Biopsy; D016015:Logistic Models; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology*; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D017430:Prostate-Specific Antigen