title: Why and Where do We Miss Significant Prostate Cancer with Multi-parametric Magnetic Resonance Imaging followed by Magnetic Resonance-guided and Transrectal Ultrasound-guided Biopsy in Biopsy-naïve Men?
abstract: Knowledge of significant prostate (sPCa) locations being missed with magnetic resonance (MR)- and transrectal ultrasound (TRUS)-guided biopsy (Bx) may help to improve these techniques.
  
  
  
  To identify the location of sPCa lesions being missed with MR- and TRUS-Bx.
  
  
  
  In a referral center, 223 consecutive Bx-naive men with elevated prostate specific antigen level and/or abnormal digital rectal examination were included. Histopathologically-proven cancer locations, Gleason score, and tumor length were determined.
  
  
  
  All patients underwent multi-parametric MRI and 12-core systematic TRUS-Bx. MR-Bx was performed in all patients with suspicion of PCa on multi-parametric MRI (n=142).
  
  
  
  Cancer locations were compared between MR- and TRUS-Bx. Proportions were expressed as percentages, and the corresponding 95% confidence intervals were calculated.
  
  
  
  In total, 191 lesions were found in 108 patients with sPCa. From these lesion 74% (141/191) were defined as sPCa on either MR- or TRUS-Bx. MR-Bx detected 74% (105/141) of these lesions and 61% (86/141) with TRUS-Bx. TRUS-Bx detected more lesions compared with MR-Bx (140 vs 109). However, these lesions were often low risk (39%). Significant lesions missed with MR-Bx most often had involvement of dorsolateral (58%) and apical (37%) segments and missed segments with TRUS-Bx were located anteriorly (79%), anterior midprostate (50%), and anterior apex (23%).
  
  
  
  Both techniques have difficulties in detecting apical lesions. MR-Bx most often missed cancer with involvement of the dorsolateral part (58%) and TRUS-Bx with involvement of the anterior part (79%).
  
  
  
  Both biopsy techniques miss cancer in specific locations within the prostate. Identification of these lesions may help to improve these techniques.
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: martijn.schouten@radboudumc.nl.
authors.forename: Martijn G
authors.initials: MG
authors.lastname: Schouten
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Marloes
authors.initials: M
authors.lastname: van der Leest
authors.affiliation: Department of Urology, The Wesley Hospital, Brisbane, Australia.
authors.forename: Morgan
authors.initials: M
authors.lastname: Pokorny
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Hoogenboom
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Jelle O
authors.initials: JO
authors.lastname: Barentsz
authors.affiliation: Department of Urology, The Wesley Hospital, Brisbane, Australia.
authors.forename: Les C
authors.initials: LC
authors.lastname: Thompson
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Jurgen J
authors.initials: JJ
authors.lastname: Fütterer
mesh_terms: D000368:Aged; D003951:Diagnostic Errors; D051517:Digital Rectal Examination; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D007610:Kallikreins / Q000097:blood; D008279:Magnetic Resonance Imaging; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D018084:Ultrasonography, Interventional; D015854:Up-Regulation
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Biopsy; Cancer; Location; MRI; Prostate