Transperineal in-bore 3-T MR imaging-guided prostate biopsy: a prospective clinical observational study.

PURPOSE To determine the detection rate, clinical relevance, Gleason grade, and location of prostate cancer ( PCa prostate cancer ) diagnosed with and the safety of an in-bore transperineal 3-T magnetic resonance (MR) imaging-guided prostate biopsy in a clinically heterogeneous patient population. MATERIALS AND METHODS This prospective retrospectively analyzed study was HIPAA compliant and institutional review board approved, and informed consent was obtained. Eighty-seven men (mean age, 66.2 years ± 6.9) underwent multiparametric endorectal prostate MR imaging at 3 T and transperineal MR imaging-guided biopsy. Three subgroups of patients with at least one lesion suspicious for cancer were included: men with no prior PCa prostate cancer diagnosis, men with PCa prostate cancer who were undergoing active surveillance, and men with treated PCa prostate cancer and suspected recurrence. Exclusion criteria were prior prostatectomy and/or contraindication to 3-T MR imaging. The transperineal MR imaging-guided biopsy was performed in a 70-cm wide-bore 3-T device. Overall patient biopsy outcomes, cancer detection rates, Gleason grade, and location for each subgroup were evaluated and statistically compared by using χ(2) and one-way analysis of variance followed by Tukey honestly significant difference post hoc comparisons. RESULTS Ninety biopsy procedures were performed with no serious adverse events, with a mean of 3.7 targets sampled per gland. Cancer was detected in 51 (56.7%) men: 48.1% (25 of 52) with no prior PCa prostate cancer , 61.5% (eight of 13) under active surveillance, and 72.0% (18 of 25) in whom recurrence was suspected. Gleason pattern 4 or higher was diagnosed in 78.1% (25 of 32) in the no prior PCa prostate cancer and active surveillance groups. Gleason scores were not assigned in the suspected recurrence group. MR targets located in the anterior prostate had the highest cancer yield (40 of 64, 62.5%) compared with those for the other parts of the prostate (P < .001). CONCLUSION In-bore 3-T transperineal MR imaging-guided biopsy, with a mean of 3.7 targets per gland, allowed detection of many clinically relevant cancers, many of which were located anteriorly.

[1]  Thomas Hambrock,et al.  Magnetic resonance imaging guided prostate biopsy in men with repeat negative biopsies and increased prostate specific antigen. , 2010, The Journal of urology.

[2]  D. Beyersdorff,et al.  MR imaging-guided prostate biopsy with a closed MR unit at 1.5 T: initial results. , 2005, Radiology.

[3]  R. Sutherland,et al.  Outcomes of transperineal template‐guided prostate biopsy in 409 patients , 2013, BJU international.

[4]  J. Babb,et al.  Prostate cancer localization using multiparametric MR imaging: comparison of Prostate Imaging Reporting and Data System (PI-RADS) and Likert scales. , 2013, Radiology.

[5]  G. Haber,et al.  Role of magnetic resonance imaging before initial biopsy: comparison of magnetic resonance imaging‐targeted and systematic biopsy for significant prostate cancer detection , 2011, BJU international.

[6]  Pingkun Yan,et al.  Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. , 2011, The Journal of urology.

[7]  B. Adamietz,et al.  MRI-guided core biopsy of the prostate in the supine position—introduction of a simplified technique using large-bore magnet systems , 2013, European Radiology.

[8]  Xavier Leroy,et al.  Prostate cancer diagnosis: multiparametric MR-targeted biopsy with cognitive and transrectal US-MR fusion guidance versus systematic biopsy--prospective multicenter study. , 2013, Radiology.

[9]  A. D'Amico,et al.  MRI-guided diagnosis and treatment of prostate cancer. , 2001, The New England journal of medicine.

[10]  A. D'Amico,et al.  Comparing PSA outcome after radical prostatectomy or magnetic resonance imaging-guided partial prostatic irradiation in select patients with clinically localized adenocarcinoma of the prostate. , 2003, Urology.

[11]  R. Parker,et al.  Repeat Prostate Biopsy Strategies after Initial Negative Biopsy: Meta-Regression Comparing Cancer Detection of Transperineal, Transrectal Saturation and MRI Guided Biopsy , 2013, PloS one.

[12]  Nobuhiko Hata,et al.  Magnetic Resonance-guided Prostate Interventions , 2005, Topics in magnetic resonance imaging : TMRI.

[13]  A. Jemal,et al.  Global cancer transitions according to the Human Development Index (2008-2030): a population-based study. , 2012, The Lancet. Oncology.

[14]  R. Berglund,et al.  Emergence of fluoroquinolone-resistant Escherichia coli as cause of postprostate biopsy infection: implications for prophylaxis and treatment. , 2011, Urology.

[15]  Thomas Hambrock,et al.  Thirty-Two-Channel Coil 3T Magnetic Resonance-Guided Biopsies of Prostate Tumor Suspicious Regions Identified on Multimodality 3T Magnetic Resonance Imaging: Technique and Feasibility , 2008, Investigative radiology.

[16]  Takashi Arakawa,et al.  Cancer core distribution in patients diagnosed by extended transperineal prostate biopsy. , 2005, Urology.

[17]  Stephan E Maier,et al.  Multiparametric MRI of prostate cancer: An update on state‐of‐the‐art techniques and their performance in detecting and localizing prostate cancer , 2013, Journal of magnetic resonance imaging : JMRI.

[18]  M. Kattan,et al.  The utility of magnetic resonance imaging and spectroscopy for predicting insignificant prostate cancer: an initial analysis , 2007, BJU international.

[19]  A. D'Amico,et al.  MR imaging-guided prostate biopsy with surgical navigation software: device validation and feasibility. , 2001, Radiology.

[20]  Michael Uder,et al.  Magnetic Resonance Image-Guided Biopsies with a High Detection Rate of Prostate Cancer , 2012, TheScientificWorldJournal.

[21]  D. Schilling,et al.  MRI-guided prostate biopsy detects clinically significant cancer: analysis of a cohort of 100 patients after previous negative TRUS biopsy , 2012, World Journal of Urology.

[22]  Thomas Hambrock,et al.  Three-Tesla magnetic resonance-guided prostate biopsy in men with increased prostate-specific antigen and repeated, negative, random, systematic, transrectal ultrasound biopsies: detection of clinically significant prostate cancers. , 2012, European urology.

[23]  Gabor Fichtinger,et al.  An MRI-Compatible Robotic System With Hybrid Tracking for MRI-Guided Prostate Intervention , 2011, IEEE Transactions on Biomedical Engineering.

[24]  Aaron Fenster,et al.  Clinical application of a 3D ultrasound-guided prostate biopsy system. , 2011, Urologic oncology.

[25]  Nobuhiko Hata,et al.  MRI signal intensity based B‐Spline nonrigid registration for pre‐ and intraoperative imaging during prostate brachytherapy , 2009, Journal of magnetic resonance imaging : JMRI.

[26]  P. Carroll,et al.  Multiparametric magnetic resonance imaging in prostate cancer: present and future , 2008, Current opinion in urology.

[27]  Georgios Sakas,et al.  A novel stereotactic prostate biopsy system integrating pre-interventional magnetic resonance imaging and live ultrasound fusion. , 2011, The Journal of urology.

[28]  Kemal Tuncali,et al.  In-bore setup and software for 3T MRI-guided transperineal prostate biopsy , 2012, Physics in medicine and biology.

[29]  Milan Sonka,et al.  3D Slicer as an image computing platform for the Quantitative Imaging Network. , 2012, Magnetic resonance imaging.

[30]  A. Zlotta,et al.  Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. , 2001, The Journal of urology.

[31]  M. Knopp,et al.  Estimating kinetic parameters from dynamic contrast‐enhanced t1‐weighted MRI of a diffusable tracer: Standardized quantities and symbols , 1999, Journal of magnetic resonance imaging : JMRI.

[32]  Mark Emberton,et al.  Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. , 2013, European urology.

[33]  R. Paterson,et al.  Bacterial sepsis after prostate biopsy--a new perspective. , 2009, Urology.

[34]  Baris Turkbey,et al.  Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. , 2013, European urology.

[35]  H. Ahmed,et al.  Transperineal magnetic resonance image targeted prostate biopsy versus transperineal template prostate biopsy in the detection of clinically significant prostate cancer. , 2013, The Journal of urology.

[36]  Kemal Tuncali,et al.  Development and Preliminary Evaluation of a Motorized Needle Guide Template for MRI-Guided Targeted Prostate Biopsy , 2013, IEEE Transactions on Biomedical Engineering.

[37]  H Ballentine Carter,et al.  Complications after prostate biopsy: data from SEER-Medicare. , 2011, The Journal of urology.

[38]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[39]  Jan van der Meulen,et al.  Multiparametric MR imaging for detection of clinically significant prostate cancer: a validation cohort study with transperineal template prostate mapping as the reference standard. , 2013, Radiology.

[40]  H. Huisman,et al.  Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. , 2006, Radiology.

[41]  Nathan Lawrentschuk,et al.  Transperineal biopsy of the prostate—is this the future? , 2013, Nature Reviews Urology.

[42]  Shyam Natarajan,et al.  MRI–ultrasound fusion for guidance of targeted prostate biopsy , 2013, Current opinion in urology.

[43]  Ralph Strecker,et al.  Areas suspicious for prostate cancer: MR-guided biopsy in patients with at least one transrectal US-guided biopsy with a negative finding--multiparametric MR imaging for detection and biopsy planning. , 2011, Radiology.

[44]  A. Villers,et al.  Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. , 2006, The Journal of urology.

[45]  Kemal Tuncali,et al.  Image registration for targeted MRI‐guided transperineal prostate biopsy , 2012, Journal of magnetic resonance imaging : JMRI.

[46]  D. Bostwick,et al.  Three-dimensional prostate mapping biopsy has a potentially significant impact on prostate cancer management. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[47]  Gabor Fichtinger,et al.  Patient selection determines the prostate cancer yield of dynamic contrast‐enhanced magnetic resonance imaging‐guided transrectal biopsies in a closed 3‐Tesla scanner , 2007, BJU international.

[48]  C. Moore,et al.  MRI-targeted prostate biopsy: a review of technique and results , 2013, Nature Reviews Urology.

[49]  Christiaan G Overduin,et al.  MRI-Guided Biopsy for Prostate Cancer Detection: A Systematic Review of Current Clinical Results , 2013, Current Urology Reports.