Combined T2 and diffusion-weighted MR imaging with template prostate biopsies in men suspected with prostate cancer but negative transrectal ultrasound-guided biopsies.

Transperineal template prostate (TPB) biopsy has been shown to improve prostate cancer detection in men with rising PSA and previous negative TRUS biopsies. Diagnostic performance of this approach especially MR imaging and using reliable reference standard remains scantly reported.

A total of 200 patients, who were previously TRUS biopsy negative, were recruited in this study. All the participants had at least 28-core TPB under general anesthetic within 8 weeks of previous negative TRUS biopsies. In 15 men undergoing laparoscopic radical prostatectomy, prostate specimens were sectioned using custom-made molds and analyzed by experienced pathologist as a feasibility study.

In total, 120 of 200 patients (60 %) had positive TPB biopsy results. All of these men had at least one negative biopsy from transrectal route. T2 diffusion-weighted MR imaging showed no lesion in almost one-third of these men (61/200; 30.5 %). Out of these, 33 (33/61; 54 %) showed malignancy on TPB including high-grade tumors (>Gleason 7). Out of 15 patients underwent surgery with a total of 52 lesions (mean 3.5) on radical prostatectomy histology analyses, TPB detected 36 (70 %) lesions only. Some of these lesions were Gleason 7 and more mostly located in the posterior basal area of prostate.

Transperineal template biopsy technique is associated with significantly high prostate cancer detection rate in men with previous negative TRUS biopsies, however compared to radical prostatectomy histology map, a significant number of lesions can still be missed in the posterior and basal area of prostate.

World journal of urology. 2016 May 28 [Epub ahead of print]

Nissar Sheikh, Cheng Wei, Magdalena Szewczyk-Bieda, Annie Campbell, Shaukat Memon, Stephen Lang, Ghulam Nabi

Department of Urology, Pilgrim Hospital, United Lincolnshire NHS Trust, England, UK., Division of Cancer Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK., Division of Cancer Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK., Technology & Innovation in Learning Team (TILT), School of Medicine, University of Dundee, Dundee, DD1 9SY, UK., Department of Urology, Pilgrim Hospital, United Lincolnshire NHS Trust, England, UK., Department of Pathology, Ninewells Hospital, Dundee, DD1 9SY, UK., Division of Cancer Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK. .

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