Jinxing Yu MD, Presenter: Nothing to Disclose

Ann S. Fulcher MD, Abstract Co-Author: Nothing to Disclose

Mary Ann Turner MD, Abstract Co-Author: Nothing to Disclose

Liang Wang MD, PhD, Abstract Co-Author: Nothing to Disclose

Don Nguyen MD, Abstract Co-Author: Nothing to Disclose

Xiaoming Li, Abstract Co-Author: Nothing to Disclose

Sean Li MEd, Abstract Co-Author: Nothing to Disclose

To compare MRI guided prostate biopsy (MRGB) with TRUS guided biopsy in patients with persistently elevated PSA, multiple prior negative TRUS biopsies and at least a suspicious lesion at mp-MRI (Likert score ≥3). Clinical significance of detected tumors will be determined.

The study group comprises consecutive patients referred for MRGB with at least two negative TRUS GB, persistently elevated PSA greater than 4 ng/ml and at least one lesion suspicious for prostate cancer (PCa) on mp-MRI. Images of all patients were reviewed independently and blindly by two experienced radiologists who recorded Likert score for each cancer suspicious region. Patients who underwent 2 or more TRUS GB, with one additional TRUS biopsy performed at the same time period as the study group, comprised the comparison group. Clinical information and biopsy results were collected; clinical significance of detected tumors was established using accepted criteria including Gleason score.

Eighty-eight patients who underwent MRGB were included in the study group. Median number of prior negative TRUS GB was 3 (range 2–6), median PSA at time of biopsy was 13.4 ng/mL (4.1–164 ng/mL), mean PSA density was 0.44, and mean prostate volume was 56.1 cc (range 25–153 cc). PCa was detected in 47 out of 88 patients (53%). PSA density was much higher in patients with positive (0.62) vs. negative MRGB (0.24) result (p<0.001). Detection rate increased to 86.5% if MRGB was only performed in patients with MR imaging Likert score ≥3. In comparison group (n=48), 5 patients had a positive result (10.4%) at subsequent TRUS GB. Tumor detection rate was significantly higher in patients with MRGB than in those with TRUS GB (p < 0.001). All 46 of 47 patients (98%) with cancer detected with MRGB had clinically significant tumors, as compared to 60% in comparison group (p<0.001).

MRGB shows high detection rate of PCa in patients with at least 2 prior negative TRUS GB, and even higher detection rate if MRGB was only performed on patients with imaging Likert score ≥3. Tumors detected by MRGB have much higher chance of being clinically significant than those detected with repeated TRUS GB.  

The rate of false negative TRUS GB results may be as high as 35% even with multiple attempts. Our study showed MRI guided prostate biopsy yielded a very high detection rate of PCa in patients with high PSA and multiple negative TRUS biopsies.

Yu, J, Fulcher, A, Turner, M, Wang, L, Nguyen, D, Li, X, Li, S, Comparison of MRI Guided Prostate Biopsy with TRUS Guided Prostate Biopsy in Patients with Persistently Elevated PSA, Multiple (≥ 2) Prior Negative TRUS Biopsies and at Least One Suspicious Lesion at MP-MRI (Likert score ≥3).  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045692.html