Patient selection determines the prostate cancer yield of dynamic contrast-enhanced magnetic resonance imaging-guided transrectal biopsies in a closed 3-Tesla scanner
ABSTRACT To evaluate the cancer yield of transrectal prostate biopsies in a 3-T magnetic resonance imaging (MRI) scanner in patients with elevated prostate specific antigen (PSA) levels and recent negative transrectal ultrasonography (TRUS)-guided prostate biopsies.
Between July 2004 and November 2005, patients with at least one previous negative prostate biopsy within the previous 12 months had MRI-guided biopsy of the prostate in a 3-T MRI scanner. Patients with previous positive biopsies for cancer were excluded. Target selection was based on T2-weighted imaging and dynamic contrast-enhanced (DCE) imaging studies.
Thirteen patients were eligible; their median (range) age was 61 (47-74) years and PSA value 4.90 (1.3-12.3) ng/mL. Most patients had one previous negative biopsy (range 1-4). Four patients had a family history of prostate cancer. There were 37 distinct targets based on T2-weighted imaging. Fifteen of 16 distinct DCE abnormalities were co-localized with a target based on T2-weighted imaging. Despite this correlation, only one of 13 patients had a directed biopsy positive for cancer. Including systematic biopsies, two of 13 patients had a biopsy positive for prostate cancer. One patient had prostate intraepithelial neoplasia and one had atypical glands in the specimen.
The prostate-cancer yield of transrectal biopsies in a 3-T MRI scanner, among patients with recent negative TRUS-guided prostate biopsies, is similar to repeat systematic TRUS-guided biopsy. DCE correlates with T2-imaging but does not appear to improve prostate cancer yield in this population.
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ABSTRACT: Purpose To determine the detection rate, clinical relevance, Gleason grade, and location of prostate cancer (PCa) diagnosed with and the safety of an in-bore transperineal 3-T magnetic resonance (MR) imaging-guided prostate biopsy in a clinically heterogeneous patient population. Materials and Methods This prospective retrospectively analyzed study was HIPAA compliant and institutional review board approved, and informed consent was obtained. Eighty-seven men (mean age, 66.2 years ± 6.9) underwent multiparametric endorectal prostate MR imaging at 3 T and transperineal MR imaging-guided biopsy. Three subgroups of patients with at least one lesion suspicious for cancer were included: men with no prior PCa diagnosis, men with PCa who were undergoing active surveillance, and men with treated PCa and suspected recurrence. Exclusion criteria were prior prostatectomy and/or contraindication to 3-T MR imaging. The transperineal MR imaging-guided biopsy was performed in a 70-cm wide-bore 3-T device. Overall patient biopsy outcomes, cancer detection rates, Gleason grade, and location for each subgroup were evaluated and statistically compared by using χ(2) and one-way analysis of variance followed by Tukey honestly significant difference post hoc comparisons. Results Ninety biopsy procedures were performed with no serious adverse events, with a mean of 3.7 targets sampled per gland. Cancer was detected in 51 (56.7%) men: 48.1% (25 of 52) with no prior PCa, 61.5% (eight of 13) under active surveillance, and 72.0% (18 of 25) in whom recurrence was suspected. Gleason pattern 4 or higher was diagnosed in 78.1% (25 of 32) in the no prior PCa and active surveillance groups. Gleason scores were not assigned in the suspected recurrence group. MR targets located in the anterior prostate had the highest cancer yield (40 of 64, 62.5%) compared with those for the other parts of the prostate (P < .001). Conclusion In-bore 3-T transperineal MR imaging-guided biopsy, with a mean of 3.7 targets per gland, allowed detection of many clinically relevant cancers, many of which were located anteriorly. © RSNA, 2014.Radiology 09/2014; DOI:10.1148/radiol.14140221 · 6.21 Impact Factor
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ABSTRACT: The detection rate of prostate cancer (PCa) using traditional biopsy guided by transrectal ultrasound (TRUS) is not satisfactory. The aim of this study was to determine the utility of 3-Tesla (3-T) magnetic resonance imaging (MRI) prior to TRUS-guided prostate biopsy and to investigate which subgroup of patients had the most evident improvement in PCa detection rate. A total of 420 patients underwent 3-T MRI examination prior to the first prostate biopsy and the positions of suspicious areas were recorded respectively. TRUS-guided biopsy regimes included systematic 12-core biopsy and targeted biopsy identified by MRI. Patients were divided into subgroups according to their serum prostate-specific antigen (PSA) levels, PSA density (PSAD), prostate volume, TRUS findings and digital rectal examination (DRE) findings. The ability of MRI to improve the cancer detection rate was evaluated. The biopsy positive rate of PCa was 41.2% (173/420), and 41 of the 173 (23.7%) patients were detected only by targeted biopsy in the MRI-suspicious area. Compared with the systematic biopsy, the positive rate was significantly improved by the additional targeted biopsy (P=0.0033). The highest improvement of detection rate was observed in patients with a PSA level of 4-10 ng/ml, PSAD of 0.12-0.20 ng/ml(2), prostate volume >50 ml, negative TRUS findings and negative DRE findings (P<0.05). Therefore, it is considered that 3-T MRI examination could improve the PCa detection rate on first biopsy, particularly in patients with a PSA level of 4-10 ng/ml, PSAD of 0.12-0.20 ng/ml(2), prostate volume of >50 ml, negative TRUS findings and negative DRE findings.Experimental and therapeutic medicine 01/2015; 9(1):207-212. DOI:10.3892/etm.2014.2061 · 0.94 Impact Factor
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ABSTRACT: Objectives: Nonreal-time Positron Emission Tomography/Computed Tomography (PET/CT) biopsies that use the image co-registration of a prior PET with an intra-procedural CT have been reported. The aim of this study was to report the initial experience of performing real-time intra-procedural PET/CT-guided biopsies. Materials and Methods: All patients (n = 4) had a prior PET/CT examination of the concerning lesion and no significant CT correlate. On the day of the biopsy, 5 mCi of 18F-fluorodeoxyglucose (FDG) or NaF18 was intravenously injected. After 60 min of biodistribution of the molecular probe, PET/CT images were obtained in a limited one bed position over the region of the concerning lesion to be biopsied. Results: One patient had a mesenteric mass and the other three had bone lesions, one located in the rib and two in the iliac bone. The pathology report revealed that two lesions (50%) were malignant and two lesions (50%) were benign. The results of the biopsy changed management in all cases. There was 0% complication rate. Conclusions: No additional software or hardware is required to perform real-time intra-procedural PET/CT-guided biopsies. It can optimize the yield, especially in cases where there are no anatomical abnormalities. Real-time intra-procedural PET/CT biopsy may have benefits over conventional biopsy techniques in terms of accuracy.09/2014; 4:54. DOI:10.4103/2156-7514.141941