Value of Targeted Prostate Biopsy Using Magnetic Resonance-ultrasound Fusion in Men with Prior Negative Biopsy and Elevated Prostate-specific Antigen

Overview

Journal Eur Urol

Specialty Urology

Date 2013 Mar 26

PMID 23523537

Citations 167

Authors

Geoffrey A Sonn

Edward Chang

Shyam Natarajan

Daniel J Margolis

Malu Macairan

Patricia Lieu

Jiaoti Huang

Frederick J Dorey

Robert E Reiter

Leonard S Marks

Affiliations

Soon will be listed here.

Abstract

Background: Conventional biopsy fails to detect the presence of some prostate cancers (PCas). Men with a prior negative biopsy but persistently elevated prostate-specific antigen (PSA) pose a diagnostic dilemma, as some harbor elusive cancer.

Objective: To determine whether use of magnetic resonance-ultrasound (MR-US) fusion biopsy results in improved detection of PCa compared to repeat conventional biopsy.

Design, Setting, And Participants: In a consecutive-case series, 105 subjects with prior negative biopsy and elevated PSA values underwent multiparametric magnetic resonance imaging (MRI) and fusion biopsy in an outpatient setting.

Intervention: Suspicious areas on multiparametric MRI were delineated and graded by a radiologist; MR-US fusion biopsy was performed by a urologist using the Artemis device; targeted and systematic biopsies were obtained regardless of MRI result.

Outcome Measurements And Statistical Analysis: Detection rates of all PCa and clinically significant PCa (Gleason ≥3+4 or Gleason 6 with maximal cancer core length ≥4 mm) were determined. The yield of targeted biopsy was compared to systematic biopsy. The ability of an MRI grading system to predict clinically significant cancer was investigated. Stepwise multivariate logistic regression analysis was performed to determine predictors of significant cancer on biopsy.

Results And Limitations: Fusion biopsy revealed PCa in 36 of 105 men (34%; 95% confidence interval [CI], 25-45). Seventy-two percent of men with PCa had clinically significant disease; 21 of 23 men (91%) with PCa on targeted biopsy had significant cancer compared to 15 of 28 (54%) with systematic biopsy. Degree of suspicion on MRI was the most powerful predictor of significant cancer on multivariate analysis. Twelve of 14 (86%) subjects with a highly suspicious MRI target were diagnosed with clinically significant cancer.

Conclusions: MR-US fusion biopsy provides improved detection of PCa in men with prior negative biopsies and elevated PSA values. Most cancers found were clinically significant.

Citing Articles

Focal therapy of prostate cancer: Use of artificial intelligence to define tumour volume and predict treatment outcomes.

Brisbane W, Priester A, Nguyen A, Topoozian M, Mota S, Delfin M BJUI Compass. 2025; 6(1):e456.

PMID: 39877558 PMC: 11771490. DOI: 10.1002/bco2.456.

Performance of MR fusion biopsy, systematic biopsy and combined biopsy on prostate cancer detection rate in 1229 patients stratified by PI-RADSv2 score on 3T multi-parametric MRI.

Riskin-Jones H, Raman A, Kulkarni R, Arnold C, Sisk A, Felker E Abdom Radiol (NY). 2025; .

PMID: 39825007 DOI: 10.1007/s00261-024-04753-3.

Prioritizing precision: detection of prostate cancer using mri guided fusion needle biopsy across the pennsylvania urologic regional collaborative.

Head D, Ako A, Ginzburg S, Singer E, Jacobs B, Fonshell C Am J Clin Exp Urol. 2024; 12(5):323-330.

PMID: 39584010 PMC: 11578769. DOI: 10.62347/BPCP1813.

Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy.

Yuan H, Huang M, Liu T, Song W, Luo C Open Med (Wars). 2024; 19(1):20241026.

PMID: 39291281 PMC: 11406436. DOI: 10.1515/med-2024-1026.

Evaluation of the Effects of Opium on the Expression of and in Wistar Rat Bladder.

Oskouie I, Zareian Baghdadabad L, Mashhadi R, Zahmatkesh P, Mirzaei A, Khajavi A Bladder Cancer. 2024; 10(1):47-59.

PMID: 38993529 PMC: 11181810. DOI: 10.3233/BLC-230076.

References

Franiel T, Stephan C, Erbersdobler A, Dietz E, Maxeiner A, Hell N . Areas suspicious for prostate cancer: MR-guided biopsy in patients with at least one transrectal US-guided biopsy with a negative finding--multiparametric MR imaging for detection and biopsy planning. Radiology. 2011; 259(1):162-72. DOI: 10.1148/radiol.10101251. View

Hadaschik B, Kuru T, Tulea C, Rieker P, Popeneciu I, Simpfendorfer T . A novel stereotactic prostate biopsy system integrating pre-interventional magnetic resonance imaging and live ultrasound fusion. J Urol. 2011; 186(6):2214-20. DOI: 10.1016/j.juro.2011.07.102. View

Sciarra A, Panebianco V, Ciccariello M, Salciccia S, Cattarino S, Lisi D . Value of magnetic resonance spectroscopy imaging and dynamic contrast-enhanced imaging for detecting prostate cancer foci in men with prior negative biopsy. Clin Cancer Res. 2010; 16(6):1875-83. DOI: 10.1158/1078-0432.CCR-09-2195. View

Merrick G, Gutman S, Andreini H, Taubenslag W, Lindert D, Curtis R . Prostate cancer distribution in patients diagnosed by transperineal template-guided saturation biopsy. Eur Urol. 2007; 52(3):715-23. DOI: 10.1016/j.eururo.2007.02.041. View

Turkbey B, Mani H, Shah V, Rastinehad A, Bernardo M, Pohida T . Multiparametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. J Urol. 2011; 186(5):1818-24. PMC: 5540658. DOI: 10.1016/j.juro.2011.07.013. View

Presti Jr J, ODowd G, Miller M, Mattu R, Veltri R . Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study. J Urol. 2002; 169(1):125-9. DOI: 10.1016/S0022-5347(05)64051-7. View

Anastasiadis A, Lichy M, Nagele U, Kuczyk M, Merseburger A, Hennenlotter J . MRI-guided biopsy of the prostate increases diagnostic performance in men with elevated or increasing PSA levels after previous negative TRUS biopsies. Eur Urol. 2006; 50(4):738-48. DOI: 10.1016/j.eururo.2006.03.007. View

Welch H, Fisher E, Gottlieb D, Barry M . Detection of prostate cancer via biopsy in the Medicare-SEER population during the PSA era. J Natl Cancer Inst. 2007; 99(18):1395-400. DOI: 10.1093/jnci/djm119. View

Roehl K, Antenor J, Catalona W . Serial biopsy results in prostate cancer screening study. J Urol. 2002; 167(6):2435-9. View

10.

Moore C, Kasivisvanathan V, Eggener S, Emberton M, Futterer J, Gill I . Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. Eur Urol. 2013; 64(4):544-52. DOI: 10.1016/j.eururo.2013.03.030. View

11.

Natarajan S, Marks L, Margolis D, Huang J, Macairan M, Lieu P . Clinical application of a 3D ultrasound-guided prostate biopsy system. Urol Oncol. 2011; 29(3):334-42. PMC: 3432280. DOI: 10.1016/j.urolonc.2011.02.014. View

12.

Pinto P, Chung P, Rastinehad A, Baccala Jr A, Kruecker J, Benjamin C . Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. J Urol. 2011; 186(4):1281-5. PMC: 3193933. DOI: 10.1016/j.juro.2011.05.078. View

13.

Sonn G, Natarajan S, Margolis D, Macairan M, Lieu P, Huang J . Targeted biopsy in the detection of prostate cancer using an office based magnetic resonance ultrasound fusion device. J Urol. 2012; 189(1):86-91. PMC: 3561472. DOI: 10.1016/j.juro.2012.08.095. View

14.

Hodge K, McNeal J, Terris M, Stamey T . Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989; 142(1):71-4; discussion 74-5. DOI: 10.1016/s0022-5347(17)38664-0. View

15.

Ahmed H, Hu Y, Carter T, Arumainayagam N, Lecornet E, Freeman A . Characterizing clinically significant prostate cancer using template prostate mapping biopsy. J Urol. 2011; 186(2):458-64. DOI: 10.1016/j.juro.2011.03.147. View

16.

Hoeks C, Schouten M, Bomers J, Hoogendoorn S, Hulsbergen-van de Kaa C, Hambrock T . Three-Tesla magnetic resonance-guided prostate biopsy in men with increased prostate-specific antigen and repeated, negative, random, systematic, transrectal ultrasound biopsies: detection of clinically significant prostate cancers. Eur Urol. 2012; 62(5):902-9. DOI: 10.1016/j.eururo.2012.01.047. View

17.

Puppo P . Repeated negative prostate biopsies with persistently elevated or rising PSA: a modern urologic dilemma. Eur Urol. 2007; 52(3):639-41. DOI: 10.1016/j.eururo.2007.04.004. View

18.

Zaytoun O, Moussa A, Gao T, Fareed K, Stephen Jones J . Office based transrectal saturation biopsy improves prostate cancer detection compared to extended biopsy in the repeat biopsy population. J Urol. 2011; 186(3):850-4. DOI: 10.1016/j.juro.2011.04.069. View

19.

Djavan B, Ravery V, Zlotta A, Dobronski P, Dobrovits M, Fakhari M . Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop?. J Urol. 2001; 166(5):1679-83. View

20.

Ukimura O, Desai M, Palmer S, Valencerina S, Gross M, Abreu A . 3-Dimensional elastic registration system of prostate biopsy location by real-time 3-dimensional transrectal ultrasound guidance with magnetic resonance/transrectal ultrasound image fusion. J Urol. 2012; 187(3):1080-6. DOI: 10.1016/j.juro.2011.10.124. View