Prostate cancer: effect of postbiopsy hemorrhage on interpretation of MR images.

Abstract

Staging accuracy is significantly improved when imaging is deferred for 21 days after biopsy.

The predictability of T3 disease in staging MRI following prostate biopsy decreases in patients with high initial PSA and Gleason score

“…19 Post-biopsy T1-weighted MRI has been shown to exhibit high signal-intensity changes in 28%-77% of patients. 5,20 Due to these limitations, investigators in prior studies have recommended an interval of 3 weeks between biopsy and MRI, 20 and investigators in a more recent study suggested that a post-biopsy interval of 8 weeks before MRI may be more beneficial. 12 However, in this series, the mean interval from biopsy to MRI was only 26 days, and MRI was taken within 3 weeks in 53.7% of patients.…”

“…Capsular irregularity is also considered an important MRI sign of ECE; 9,25 however, this irregularity may be related to trauma, including prostatic biopsy. 5 Actually, more than 20 different criteria exist for ECE. 26 In fact, previous studies have shown that if a diagnosis of extraprostatic tumour spread is based solely on obvious findings, the high specificity may be associated with a downside of extremely poor sensitivity.…”

“…Low-signal intensity lesions in the peripheral zone may also be caused by several other factors, including post-biopsy haemorrhage, prostatitis, intraglandular dysplasia and benign prostatic hyperplasia. [5][6][7][8] In particular, haemorrhage after biopsy, which is generally observed during the first 8 weeks after the procedure, is a substantial limitation of MRI in this setting, resulting in both overand underestimation of tumour extent. 9,10 Moreover, MRI cannot detect microscopic invasion; none of the currently available imaging modalities allows for detection of microscopic invasion.…”

MRT der Prostata: Empfehlungen zur Vorbereitung und Durchführung

“…The changes can be detectable many months after biopsy and can complicate tumor detection. Therefore, the time at which the biopsy was performed should be indicated [2]. Moreover, the number of biopsy specimens and the biopsy site, if available, should be specified [1].…”

“…For the prostate, a T1w sequence is also useful for detecting post-biopsy or inflammatory bleeding. This has a hyperintense appearance in T1w sequences and can thus be effectively delimited from the surrounding tissue [2].…”