BACKGROUND/AIM:Patients with previous negative transrectal ultrasound-guided biopsy (TRUS-GB) and persistently increased prostate-specific antigen (PSA) value represent a great diagnostic problem.
Magnetic resonance imaging (MRI)-guided biopsy demonstrates high prostate cancer detection rates in these patients if functional MRI is suspicious for prostate cancer. However, MRI-guided biopsy is not commonly available and features considerable technical requirements. This was a pilot study to investigate if a standard repeat TRUS-GB, with additional targeted cores to suspicious lesions on functional MRI, can achieve similar detection rates as compared to MRI-guided biopsy.
PATIENTS AND METHODS: 3 Tesla functional MRI was performed in 58 patients with ≥1 previous negative biopsy, persistently increased PSA ≥4 ng/ml and unsuspicious digital rectal examination. Suspicious lesions were marked on a localization map to enable their finding on TRUS. Random TRUS-GB with additional targeted cores according to the functional MRI findings were performed in patients with ≥1 suspicious lesion.
RESULTS: In 37.9% (22/58), functional MRI demonstrated suspicious findings. Out of these 22 patients, 16 underwent TRUS-GB with additional targeted cores. Prostate cancer was diagnosed in 68.8% (11/16). Eight out of these 11 patients subsequently underwent radical prostatectomy and all tumors fulfilled criteria for high-risk prostate cancer. With a median follow-up of 49.1 weeks neither significant PSA increase nor prostate cancer was detected in patients with normal functional MRI findings.
CONCLUSION: Our approach enables excellent detection rates of clinically significant prostate cancer in patients with ≥1 previous negative biopsy and persistently increased PSA levels. Due to the current disadvantages of MRI-guided biopsy, our approach therefore represents an excellent alternative to MRI-guided biopsy.
Written by:
Arsov C, Quentin M, Rabenalt R, Antoch G, Albers P, Blondin D. Are you the author?
Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
Reference: Anticancer Res. 2012 Mar;32(3):1087-92.
PubMed Abstract
PMID: 22399637
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