MRI-guided biopsy of the prostate increases diagnostic performance in men with elevated or increasing PSA levels after previous negative TRUS biopsies.

OBJECTIVES Repeatedly negative prostate biopsies in individuals with elevated prostate specific antigen (PSA) levels can be frustrating for both the patient and the urologist. This study was performed to investigate if magnetic resonance imaging (MRI)-guided transrectal biopsy increases diagnostic performance in individuals with elevated or increasing PSA levels after previous negative conventional transrectal ultrasound (TRUS)-guided biopsies. METHODS 27 consecutive men with a PSA >4 ng/ml and/or suspicious finding on digital rectal examination, suspicious MRI findings, and at least one prior negative prostate biopsy were included. Median age was 66 years (mean, 64.5+/-6.8); median PSA was 10.2 ng/ml (mean, 11.3+/-5.5). MRI-guided biopsy was performed with a closed unit at 1.5 Tesla, an MRI-compatible biopsy device, a needle guide, and a titanium double-shoot biopsy gun. RESULTS Median prostate volume was 37.4 cm3 (mean, 48.4+/-31.5); median volume of tumor suspicious areas on T2w MR images was 0.83 cm3 (mean, 0.99+/-0.78). The mean number of obtained cores per patient was 5.22+/-1.45 (median, 5; range, 2-8). Prostate cancer was detected in 55.5% (15 of 27) of the men. MRI-guided biopsy could be performed without complications in all cases. CONCLUSION According to our knowledge, this is the largest cohort of consecutive men to be examined by MRI-guided transrectal biopsy of the prostate in this setting. The method is safe, can be useful to select suspicious areas in the prostate, and has the potential to improve cancer detection rate in men with previous negative TRUS-biopsies.

[1]  W S Ng,et al.  Endorectal magnetic resonance imaging and spectroscopy for the detection of tumor foci in men with prior negative transrectal ultrasound prostate biopsy. , 2004, The Journal of urology.

[2]  M. Mori,et al.  Clinical outcomes of androgen deprivation as the sole therapy for localized and locally advanced prostate cancer , 2005, BJU international.

[3]  E. Bergstralh,et al.  Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate‐specific antigen testing: 15‐year outcome , 2005, BJU international.

[4]  M. Zerbib,et al.  Negative prostatic biopsies in patients with a high risk of prostate cancer. Is the combination of endorectal MRI and magnetic resonance spectroscopy imaging (MRSI) a useful tool? A preliminary study. , 2005, European urology.

[5]  M. Kattan,et al.  Achieving optimal outcomes after radical prostatectomy. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[6]  M Bolla,et al.  EAU guidelines on prostate cancer. , 2001, European urology.

[7]  Chinyere N. Onyebuchi,et al.  The role of preoperative endorectal magnetic resonance imaging in the decision regarding whether to preserve or resect neurovascular bundles during radical retropubic prostatectomy , 2004, Cancer.

[8]  M. Remzi,et al.  Prostate biopsy: who, how and when. An update. , 2005, The Canadian journal of urology.

[9]  Bernd Hamm,et al.  Patients with a history of elevated prostate-specific antigen levels and negative transrectal US-guided quadrant or sextant biopsy results: value of MR imaging. , 2002, Radiology.

[10]  C. Pfister,et al.  Current usefulness of free/total PSA ratio in the diagnosis of prostate cancer at an early stage , 2005, World Journal of Urology.

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

[12]  J. Crowley,et al.  Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. , 2004, The New England journal of medicine.

[13]  J. Bosch,et al.  Validity of digital rectal examination and serum prostate specific antigen in the estimation of prostate volume in community-based men aged 50 to 78 years: the Krimpen Study. , 2004, European urology.

[14]  M. Luján,et al.  Prostate cancer detection and tumor characteristics in men with multiple biopsy sessions , 2004, Prostate Cancer and Prostatic Diseases.

[15]  W. Catalona,et al.  Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. , 1991, The New England journal of medicine.

[16]  S. Zangos,et al.  MR-guided transgluteal biopsies with an open low-field system in patients with clinically suspected prostate cancer: technique and preliminary results , 2004, European Radiology.

[17]  H. D. de Koning,et al.  Prostate cancer detection at low prostate specific antigen. , 2000, The Journal of urology.

[18]  J. Kurhanewicz,et al.  Prostatic biopsy directed with endorectal MR spectroscopic imaging findings in patients with elevated prostate specific antigen levels and prior negative biopsy findings: early experience. , 2005, Radiology.

[19]  Mesut Remzi,et al.  Can Power Doppler enhanced transrectal ultrasound guided biopsy improve prostate cancer detection on first and repeat prostate biopsy? , 2004, European urology.

[20]  M. Remzi,et al.  Can total and transition zone volume of the prostate determine whether to perform a repeat biopsy? , 2003, Urology.

[21]  M. Remzi,et al.  The Vienna nomogram: validation of a novel biopsy strategy defining the optimal number of cores based on patient age and total prostate volume. , 2005, The Journal of urology.

[22]  H. Schlemmer,et al.  Can pre-operative contrast-enhanced dynamic MR imaging for prostate cancer predict microvessel density in prostatectomy specimens? , 2004, European Radiology.

[23]  Freddie C Hamdy,et al.  Use of prostate-specific antigen (PSA) isoforms for the detection of prostate cancer in men with a PSA level of 2-10 ng/ml: systematic review and meta-analysis. , 2005, European urology.