Prebiopsy MRI and MRI-ultrasound Fusion-targeted Prostate Biopsy in Men with Previous Negative Biopsies: Impact on Repeat Biopsy Strategies

Neil Mendhiratta, Xiaosong Meng, Andrew B. Rosenkrantz, James S. Wysock, Michael Fenstermaker, Richard Huang, Fang Ming Deng, Jonathan Melamed, Ming Zhou, William C. Huang, Herbert Lepor, Samir S. Taneja

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Abstract

Objective To report outcomes of magnetic resonance imaging (MRI)-ultrasound fusion-targeted biopsy (MRF-TB) and 12-core systematic biopsy (SB) over a 26-month period in men with prior negative prostate biopsy. Materials and Methods Between June 2012 and August 2014, 210 men presenting to our institution for prostate biopsy with ≥1 prior negative biopsy underwent multiparametric MRI followed by MRF-TB and SB and were entered into a prospective database. Clinical characteristics, maximum mpMRI suspicion scores (mSS), and biopsy results were queried from the database, and the detection rates of Gleason ≥7 prostate cancer (PCa) and overall PCa were compared between biopsy techniques using McNemar's test. Results Forty seven (29%) of 161 men meeting inclusion criteria (mean age, 65 ± 8 years; mean prostate-specific antigen, 8.9 ± 8.9) were found to have PCa. MRF-TB and SB had overall cancer detection rates (CDRs) of 21.7% and 18.6% (P =.36), respectively, and CDR for Gleason score (GS) ≥7 disease of 14.9% and 9.3% (P =.02), respectively. Of 26 men with GS ≥7 disease, MRF-TB detected 24 (92.3%) whereas SB detected 15 (57.7%; P <.01). Using UCSF-CAPRA criteria, only 1 man was restratified from low risk to higher risk based on SB results compared to MRF-TB alone. Among men with mSS <4, 72% of detected cancers were low risk by UCSF-CAPRA criteria. Conclusion In men with previous negative biopsies and persistent suspicion of PCa, SB contributes little to the detection of GS ≥7 disease by MRF-TB, and avoidance of SB bears consideration. Based on the low likelihood of detecting GS ≥7 cancer and overall low-risk features of PCa in men with mSS <4, limiting biopsy to men with mSS ≥4 warrants further investigation.

Original languageEnglish (US)
Pages (from-to)1192-1198
Number of pages7
JournalUrology
Volume86
Issue number6
DOIs
StatePublished - Dec 1 2015

ASJC Scopus subject areas

  • Urology

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    Mendhiratta, N., Meng, X., Rosenkrantz, A. B., Wysock, J. S., Fenstermaker, M., Huang, R., Deng, F. M., Melamed, J., Zhou, M., Huang, W. C., Lepor, H., & Taneja, S. S. (2015). Prebiopsy MRI and MRI-ultrasound Fusion-targeted Prostate Biopsy in Men with Previous Negative Biopsies: Impact on Repeat Biopsy Strategies. Urology, 86(6), 1192-1198. https://doi.org/10.1016/j.urology.2015.07.038