Is it Time to Perform Only Magnetic Resonance Imaging Targeted Cores? Our Experience with 1,032 Men Who Underwent Prostate Biopsy

Abstract

Multiparametric magnetic resonance imaging could significantly reduce the number of unnecessary repeat prostate biopsies in about 50% of cases in which a PI-RADS score of 3 or greater is used. At the same time patients should be informed of the 16.2% and 39.7% false-negative rates of clinically significant prostate cancer for targeted fusion prostate biopsy of PI-RADS 3 or greater and 4 or greater lesions, respectively.

The transrectal ultrasound/MRI fusion biopsy for prostate cancer diagnosis after previous negative biopsy: a case report

“…Another interesting characteristic is the higher negative predictive value of a normal mpMRI for PCcs that is around 90-95%, making the exam a useful tool in determining whether a patient is a candidate for biopsy. Based on this finding some authors propose that a normal resonance be enough to not indicate a biopsy and that in the case of an altered MRI we could only sample the suspected lesion 10 .…”

Early Second Round Targeted Biopsy of PI-RADS Score 3 or 4 in 256 Men With Persistent Suspicion of Prostate Cancer

“…The improvement of diagnostic imaging by mpMRI has allowed targeted biopsies of the suspicious area, increasing the diagnosis of csPCa (1) and reducing the number of unnecessary systematic biopsies. Although mpMRI is strongly recommended in men candidate for a repeat biopsy (3) or men enrolled in active surveillance protocols (15,16), still today, systematic biopsy should be always combined with mpMRI/TRUS fusion biopsy due to the increased false negative rate (1,17) of mpMRI (about 20% of the cases) (11,18,19) mpMRI/TRUS fusion biopsy platforms (20). On the other hand, an alternative clinical approach is to begin with mpMRI to determine which patients need a targeted biopsy (21,22).…”

“…On the other hand, an alternative clinical approach is to begin with mpMRI to determine which patients need a targeted biopsy (21,22). The detection rate of csPCa is directly related to the PI-RADS score (Table II) (11,(23)(24)(25)(26)(27)(28)(29)(30) and the results depend on clinical parameters, the number of previous negative biopsies and the quality of TPBx procedures; in a previous series, we reported a percentage of missed csPCa equal to 8.7 versus 23.5 versus 16.2 versus 0% in the presence of a PI-RAS score <3 versus 3 versus 4 versus 5 in patients that were diagnosed by transperineal SPBx (11). In addition, it is still unclear when and which mpMRI lesions negative for cancer should be submitted early to repeat TPBx; in this respect, about 15-20% of PI-RADS 3 could harbour a csPCa resulting in reclassification to PIRADS score 4 in a year (24,25).…”

“…All mpMRI examinations were previously performed using a 3.0 Tesla scanner, (ACHIEVA 3T; Philips Healthcare Best, the Netherlands) equipped with surface 16 channels phased-array coil placed around the pelvic area with the patient in the supine position; multi-planar turbo spinecho T2-weighted, and axial diffusion weighted imaging, and axial dynamic contrast enhanced MRI were performed for each patient (10). All the mpMRI index lesions, characterized by a PI-RADS (version 2) equal to 3 or 4, and negative for Pca, underwent second round TPBx (four cores); the procedure was performed transperineally using a Tru-Cut 18-gauge needle (Bard; Covington, GA, USA) under local anesthesia and antibiotic prophylaxis (one tablet daily of 500 mg for 3 days) (11). The TBPx was done using an Hitachi 70 Arietta echograph, Chiba, Japan) supplied by a biplanar trans-rectal probe (6).…”

Multiparametric MRI Versus SelectMDx Accuracy in the Diagnosis of Clinically Significant PCa in Men Enrolled in Active Surveillance

“…Six months after PCa diagnosis, all patients underwent digital rectal examination, total PSA, PSAD, 3.0 T pelvic mpMRI and confirmatory transperineal saturation biopsy (SPBx: 30 cores; 24 in the periphery and six in the anterior zone). The procedure was performed with the use of a GE Logiq P6 ecograph (General Electric, Milwaukee, WI, USA) supplied with a biplanar transrectal probe (5-7.5 MHz) using a trucut 18 gauge needle (Bard, Covington, GA, USA) under sedation and antibiotic prophylaxis (19). All mpMRI examinations were performed using a 3.0 T scanner (ACHIEVA 3T; Philips Healthcare, Best, The Netherlands) equipped with a surface 16 channel phased-array coil placed around the pelvic area with the patient in the supine position.…”