Martijn Gerjan Schouten MSc, Presenter: Nothing to Disclose

Caroline Maria Anna Hoeks MD, Abstract Co-Author: Nothing to Disclose

Joyce Gerda Riek Bomers MSc, Abstract Co-Author: Nothing to Disclose

Klaas Nagel, Abstract Co-Author: Nothing to Disclose

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

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

To determine the location of prostate cancer found with magnetic resonance (MR)-guided prostate biopsy in patients with an elevated prostate specific antigen (PSA) and at least one negative transrectal ultrasound (TRUS)-guided biopsy session.

Retrospectively, 263 consecutive patients who had undergone MR-guided prostate biopsy between March 2010 and March 2011, were enrolled in this study. Inclusion criteria were patients with an elevated PSA (>4ng/ml), at least one negative TRUS-guided biopsy session and cancer positive pathological findings in biopsy specimens obtained during MR-guided prostate biopsy. Exclusion criteria were patients with an unknown number or no previous TRUS-guided biopsy sessions and pre-existent prostate cancer diagnosis or suspicion of recurrent prostate cancer. During MR-guided biopsy a confirmation scan (needle in situ) was made to verify the location of the biopsy needle. Two readers, with 1 and 2 years of experience in MR-guided prostate biopsy, determined in consensus the locations where cancer was histologically proven in the prostate. The locations were categorized according to an adapted scheme as described by Dickinson et al. The anterior part starts 17mm from the prostatic posterior surface (biopsy core length).

Sixty-eight patients met the inclusion criteria and were included (median age, 64 years; median PSA, 17.5 ng/mL; median prostate volume, 47 cc; median PSA density, 0.38 ng/ml/cc; median number of negative TRUS-guided biopsy sessions, 3) Cancer was found in 73.3% of the cases in the anterior part of the prostate. Most cancers were found in the mid prostate (56.2%) when compared to the base (17.1%) and apex (26.7%). From the tumors located in the apex, 89.3% were located in the anterior part. Furthermore, 71.2% of the tumors found in the mid prostate were located in the anterior part. In the base 55.6% of the tumors were located in the anterior part.  

In patients with an elevated PSA and at least one negative TRUS-guided biopsy session most cancers are located in the anterior part of the prostate.

By sampling the anterior part of the prostate, higher detection rates may be achieved in patients with an elevated PSA and at least one negative TRUS-guided biopsy session.

Schouten, M, Hoeks, C, Bomers, J, Nagel, K, Barentsz, J, Futterer, J, Repeated Negative Transrectal Ultrasound (TRUS)-guided Prostate Biopsies: Commonly Missed Cancer Locations Found with MR-guided Biopsies.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034247.html