E-ISSN 1305-3612
Abdominal Imaging - Original Article
Imaging and pathology findings after an initial negative MRI-US fusion-guided and 12-core extended sextant prostate biopsy session
1 Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.  
2 Center for Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.  
3 Center for Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.  
4 Center for Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.  
Diagn Interv Radiol 2014; 20: 234-238
DOI: 10.5152/dir.2014.13345
Abstract

PURPOSE 

A magnetic resonance imaging-ultrasonography (MRI-US) fusion-guided prostate biopsy increases detection rates compared to an extended sextant biopsy. The imaging characteristics and pathology outcomes of subsequent biopsies in patients with initially negative MRI-US fusion biopsies are described in this study.

 

MATERIALS AND METHODS

We reviewed 855 biopsy sessions of 751 patients (June 2007 to March 2013). The fusion biopsy consisted of two cores per lesion identified on multiparametric MRI (mpMRI) and a 12-core extended sextant transrectal US (TRUS) biopsy. Inclusion criteria were at least two fusion biopsy sessions, with a negative first biopsy and mpMRI before each.

 

RESULTS

The detection rate on the initial fusion biopsy was 55.3%; 336 patients had negative findings. Forty-one patients had follow-up fusion biopsies, but only 34 of these were preceded by a repeat mpMRI. The median interval between biopsies was 15 months. Fourteen patients (41%) were positive for cancer on the repeat MRI-US fusion biopsy. Age, prostate-specific antigen (PSA), prostate volume, PSA density, digital rectal exam findings, lesion diameter, and changes on imaging were comparable between patients with negative and positive rebiopsies. Of the patients with positive rebiopsies, 79% had a positive TRUS biopsy before referral (P = 0.004). Ten patients had Gleason 3+3 disease, three had 3+4 disease, and one had 4+4 disease.

 

 CONCLUSION

In patients with a negative MRI-US fusion prostate biopsy and indications for repeat biopsy, the detection rate of the follow-up sessions was lower than the initial detection rate. Of the prostate cancers subsequently found, 93% were low grade (≤3+4). In this low risk group of patients, increasing the follow-up time interval should be considered in the appropriate clinical setting.

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