Pre-Biopsy MRI and MRI-Ultrasound Fusion-Targeted Prostate Biopsy in Men with Previous Negative Biopsies: Impact on Repeat Biopsy Strategies.

To report outcomes of MRI-ultrasound fusion (MRF-TB) and 12-core systematic biopsy (SB) over a 26-month period in men with prior negative prostate biopsy.

Between 6/12 and 8/14, 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, MRI 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.

Fifty-three (31%) of 172 men meeting inclusion criteria (mean age 65±8 years; mean PSA 8. 9±8. 9) were found to have PCa. MRF-TB and SB had overall cancer detection rates (CDR) of 23. 8% and 18. 0% (p=0. 12), respectively, and CDR for Gleason score (GS)≥7 disease of 16. 3% and 9. 3% (p=0. 01), respectively. Of 31 men with GS≥7 disease, MRF-TB detected 28 (90. 3%) while SB detected 16 (51. 6%) (p

In men with previous negative biopsies and persistent suspicion for 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.

Urology. 2015 Aug 31 [Epub ahead of print]

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

School of Medicine, NYU Langone Medical Center, New York, NY. , Department of Urology, NYU Langone Medical Center, New York, NY. , Department of Radiology, NYU Langone Medical Center, New York, NY. , Department of Urology, NYU Langone Medical Center, New York, NY. , School of Medicine, NYU Langone Medical Center, New York, NY. , Department of Urology, NYU Langone Medical Center, New York, NY. , Department of Pathology, NYU Langone Medical Center, New York, NY. , Department of Pathology, NYU Langone Medical Center, New York, NY. , Department of Pathology, NYU Langone Medical Center, New York, NY. , Department of Urology, NYU Langone Medical Center, New York, NY. , Department of Urology, NYU Langone Medical Center, New York, NY. , Department of Urology, NYU Langone Medical Center, New York, NY; Department of Radiology, NYU Langone Medical Center, New York, NY.  

PubMed