Thomas Hambrock MBChB, Presenter: Nothing to Disclose

Jurgen J. Futterer MD, Abstract Co-Author: Nothing to Disclose

Henkjan Huisman PhD, Abstract Co-Author: Research grant, U-Systems, Inc Stockholder, U-Systems, Inc Stockholder, QView Medical, Inc

Inge van Oort MD, Abstract Co-Author: Nothing to Disclose

Fred Witjes MD, PhD, Abstract Co-Author: Nothing to Disclose

Jelle O. Barentsz MD, PhD, Abstract Co-Author: Nothing to Disclose

To determine the tumor detection rate, Gleason score distribution and location of tumors detected with 3T MR guided prostate biopsies of tumor suspicious regions (TSR) identified on T2-weighted, Diffusion Weighted (DWI) and Dynamic Contrast Enhanced (DCE-MRI) imaging in patients with a high PSA (> 4 ng/ml) and at least two previous negative prostate biopsy sessions.

63 Patients with high PSA > 4 ng/ml and at least two prior negative transrectal ultrasound (TRUS) guided biopsies received a multi-modality (T2-w, DWI and DCE-MRI) 3T MRI (Trio Tim, Siemens, Germany) for prostate cancer detection. Two radiologists in consensus determined up to three different TSRs using the multi-modality images. An MR biopsy device (Invivo, Germany) was used at 3T to perform prostate biopsies of these TSRs.

The patients had a median PSA value of 13 ng/ml (range 4-123), mean age of 61 years and a median of 2 (range 2 – 7) previous negative TRUS guided biopsies. A total of 106 TSRs in 63 patients were biopsied with a total of 240 cores obtained. The tumor detection rate was 57% (36 of 63 patients). Of the 106 TSRs, 42 (40%) were positive for tumor. The prevalence of Gleason 5 tumors was 5% (2/42), Gleason 6, 50%(21/42), Gleason 7, 29% (12/42), Gleason 8, 14% (6/42) and Gleason 9 tumors, 2% (1/42). The location of tumors diagnosed were: transition zone - 57% (24/42), peripheral zone - 33% (14/42) and central zone - 10% (4/42). The median number of biopsies obtained was 4 (range 1 to 7) and mean duration of MR guided biopsies was 31 min (range 14-75 min). Apart from one transient transurethral hemorrhage and one urinary tract infection, no significant procedure related side-effects occurred.

MR guided biopsies targeted towards multi-modality 3T MRI determined TSRs is an effective method for detecting prostate cancer in patients with high risk of prostate cancer based on elevated PSA and at least two prior negative biopsies. A large number (45%) of aggressive tumors (Gleason ≥ 7) were found and the predominant location of tumor was in the transition zone.

Repeat negative biopsies represent a clinical problem faced by urologists. Early detection of significant tumors is crucial to establish effective, potentially curative treatment.   

Hambrock, T, Futterer, J, Huisman, H, van Oort, I, Witjes, F, Barentsz, J, Value of 3 Tesla Multimodality-directed MR-guided Biopsy to Detect Prostate Cancer in High-risk Patients after at Least Two Previous Negative Biopsies.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6020367.html