Men with a negative real-time MRI/ultrasound-fusion guided targeted biopsy but prostate cancer detection on TRUS-guided random biopsy - what are the reasons for targeted biopsy failure?

To examine the value of additional TRUS-guided random biopsy (RB) in patients with negative MRI/Ultrasound-fusion guided targeted biopsy (TB) and to identify possible reasons for TB failure.

Subgroup analysis of 61 men with prostate cancer (PCa) detection by 10-core RB but negative TB in a cohort of 408 men with suspicious multiparemetric MRI (mpMRI) between January 2012 and January 2015.

Consensus re-reading of mpMRI (using both PI-RADS version 1 and version 2) of each suspicious lesion blinded to the biopsy results, followed by an un-blinded anatomic correlation of the lesion on mpMRI to the biopsy result. The potential reasons for TB failure were estimated for each lesion. Definition of clinically significant PCa according to Epstein criteria and stratification into risk groups according to the EAU guideline.

RB detected significant PCa in 64% (39/61) and intermediate/high risk PCa in 57% (35/61). The initial reading of mpMRI identified 90 suspicious lesions (PI-RADS ≥3) in the cohort. Blinded consensus re-reading of the mpMRI led to PI-RADS score downgrading of 45 (50%) lesions and upgrading of 13 (14%) lesions. Thus negative TB could be explained by a false high initial PI-RADS score for 32 (34%) lesions and sampling of the target lesion by RB in the corresponding anatomic site for 36 of 90 lesions (40%) in 35 of 61 (57%) patients. Sampling the target lesion by RB was most likely for lesions with PI-RADS scores 4/5 and a Gleason score ≥7. 70 PCa lesions (67% Gleason score 6) in 44 (72%) patients were sampled from prostatic sites with no abnormalities on mpMRI.

In case of TB failure, RB still detected a high rate of significant PCa. The main reason for a negative TB was a TB error, compensated by positive sampling of the target lesion by the additional RB and the second reason for TB failure was a false high initial PI-RADS score. The challenges of both MRI diagnostics and prostate lesion sampling are evident in our collective and support the integration of RB into the TB workflow. This article is protected by copyright. All rights reserved.

BJU international. 2015 Sep 19 [Epub ahead of print]

Hannes Cash, Karsten Günzel, Andreas Maxeiner, Carsten Stephan, Thomas Fischer, Tahir Durmus, Kurt Miller, Patrick Asbach, Matthias Haas, Carsten Kempkensteffen

Department of Urology, Charité - University Medicine Berlin, Berlin, Germany. , Department of Urology, Charité - University Medicine Berlin, Berlin, Germany. , Department of Urology, Charité - University Medicine Berlin, Berlin, Germany. , Department of Urology, Charité - University Medicine Berlin, Berlin, Germany. , Departement of Radiology, Charité - University Medicine Berlin, Berlin, Germany. , Departement of Radiology, Charité - University Medicine Berlin, Berlin, Germany. , Department of Urology, Charité - University Medicine Berlin, Berlin, Germany. , Departement of Radiology, Charité - University Medicine Berlin, Berlin, Germany. , Departement of Radiology, Charité - University Medicine Berlin, Berlin, Germany. , Department of Urology, Charité - University Medicine Berlin, Berlin, Germany.

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