Transperineal in-bore 3-T MR imaging-guided prostate biopsy: A prospective clinical observational study - 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 χ2 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.

Written by:
Penzkofer T, Tuncali K, Fedorov A, Song SE, Tokuda J, Fennessy FM, Vangel MG, Kibel AS, Mulkern RV, Wells WM, Hata N, Tempany CM.   Are you the author?
Division of MRI in the Department of Radiology and the Division of Urology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany. Department of Radiology, Massachusetts General Hospital, Boston, Mass; Department of Radiology, Dana-Farber Cancer Institute, Boston, Mass; and Department of Radiology, Children's Hospital, Boston, Mass.

Reference: Radiology. 2014 Sep 15:140221.
doi: 10.1148/radiol.14140221

PubMed Abstract
PMID: 25222067 Prostate Cancer Section