Magnetic resonance imaging-guided biopsies may improve diagnosis in biopsy-naive men with suspicion of prostate cancer

Abstract

Introduction: The purpose of this pilot study was to investigate whether a short prostate biparametric magnetic resonance imaging (bp-MRI) protocol provides a valuable diagnostic addition for biopsy guidance in biopsy-naive men with a suspicion of prostate cancer (PCa).

Methods: A total of 62 biopsy-naive patients referred to a systematic transrectal ultrasound biopsy (TRUS-bx) due to suspicion of PCa were prospectively enrolled. Bp-MRI was performed before biopsy. All lesions were scored according to the modified Prostate Imaging Reporting and Data System (PI-RADS) version 2. All patients underwent TRUS-bx followed by bp-MRI-guided biopsies (bp-MRI-bx) under MRI/TRUS image fusion from any bp-MRI suspicious lesions not obviously targeted by TRUS-bx.

Results: PCa was found in 42 (68%) and 32 (52%) patients by TRUS-bx and bp-MRI-bx, respectively. Bp-MRI-bx de-tected PCa in one patient who had been missed by TRUS-bx, and found the highest Gleason score (GS) in 13 (30%) patients leading to an overall GS upgrade in six (14%) patients. Bp-MRI missed nine patients with GS = 6 and two with a GS = 7 (3 + 4), all of whom were diagnosed by TRUS-bx.

Conclusions: Addition of bp-MRI-bx to routine TRUS-bx seems feasible in biopsy-naive patients and may improve the detection of aggressive PCa in first-round biopsies. This pilot study thus provides an incentive for a larger investigation.

Funding: Costs were covered by the Department of Radiology, Herlev Hospital, Denmark.

Trial registration: This study was registered with the Danish Data Protection Agency (HEH-2015-054, I-Suite no: 03775) and with the Committee for Health Research Ethics (no. H-15009341).