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. 2023 May 17;13(10):1761.
doi: 10.3390/diagnostics13101761.

Detection Rate of Prostate Cancer in Repeat Biopsy after an Initial Negative Magnetic Resonance Imaging/Ultrasound-Guided Biopsy

Magdalena Görtz  1   2 , Ann-Kathrin Huber  3 , Tim Linz  3 , Constantin Schwab  4 , Albrecht Stenzinger  4 , Lukas Goertz  5 , David Bonekamp  6 , Heinz-Peter Schlemmer  6 , Markus Hohenfellner  1
Affiliations

Detection Rate of Prostate Cancer in Repeat Biopsy after an Initial Negative Magnetic Resonance Imaging/Ultrasound-Guided Biopsy

Magdalena Görtz et al. Diagnostics (Basel). .

Abstract

A negative multiparametric magnetic resonance imaging (mpMRI)-guided prostate biopsy in patients with suspected prostate cancer (PC) results in clinical uncertainty, as the biopsy can be false negative. The clinical challenge is to determine the optimal follow-up and to select patients who will benefit from repeat biopsy. In this study, we evaluated the rate of significant PC (sPC, Gleason score ≥7) and PC detection in patients who received a follow-up mpMRI/ultrasound-guided biopsy for persistent PC suspicion after a negative mpMRI/ultrasound-guided biopsy. We identified 58 patients at our institution that underwent repeat targeted biopsy in case of PI-RADS lesions and systematic saturation biopsy between 2014 and 2022. At the initial biopsy, the median age was 59 years, and the median prostate specific antigen level was 6.7 ng/mL. Repeat biopsy after a median of 18 months detected sPC in 3/58 (5%) patients and Gleason score 6 PC in 11/58 (19%). Among 19 patients with a downgraded PI-RADS score at the follow-up mpMRI, none had sPC. In conclusion, men with an initial negative mpMRI/ultrasound-guided biopsy had a high likelihood of not harboring sPC at repeat biopsy (95%). Due to the small size of the study, further research is recommended.

Keywords: MRI/TRUS fusion biopsy; PI-RADS; magnetic resonance imaging; prostate cancer; prostate-specific antigen.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart for study inclusion. MRI = multiparametric imaging; PSA = prostate-specific antigen.
Figure 2
Figure 2
Axial mpMRI of a patient with sPC detection at repeat biopsy (Patient I). (a) Initial T2-weighted mpMRI without PC detection at initial biopsy (PI-RADS lesion 3, the suspicious lesion is marked with an arrow); (b) the PI-RADS 4 lesion visible in the repeat mpMRI does not yet present itself in the initial mpMRI (T2-weighted image); (c) repeat mpMRI of Patient I with sPC detection at repeat biopsy (new PI-RADS lesion 4, T2-weighted); (d) ADC decrease in the PI-RADS lesion 4 at repeat biopsy; (e) signal increase in the high b-value image at repeat biopsy.
Figure 3
Figure 3
Axial mpMRI of a patient with sPC detection at repeat biopsy (Patient II). (a) Initial T2-weighted mpMRI of Patient II without PC detection at initial biopsy (PI-RADS lesion 4, the suspicious lesion is marked with an arrow); (b) repeat mpMRI of Patient II with sPC detection at repeat biopsy (persistent PI-RADS lesion 4, T2-weighted); (c) flat ADC decrease in the PI-RADS 4 lesion at repeat biopsy; (d) flat signal increase in the PI-RADS 4 lesion in the high b-value image at repeat biopsy.
Figure 4
Figure 4
Axial mpMRI of a patient without PC detection at initial and repeat biopsy (Patient III). (a) Initial mpMRI of Patient III without PC detection at initial biopsy (PI-RADS lesion 4, T2-weighted image, the suspicious lesion is marked with an arrow); (b) marked ADC reduction in the PI-RADS 4 lesion at initial biopsy; (c) marked signal enhancement of the PI-RADS 4 lesion in the high b-value image at initial biopsy; (d) repeat mpMRI of Patient III without PC detection at repeat biopsy (PI-RADS lesion 3, T2-weighted image, focal lesion regressive T2 hypointense); (e) flat ADC reduction in the PI-RADS 3 lesion at repeat biopsy; (f) signal enhancement of the PI-RADS 3 lesion in the high b-value image at repeat biopsy.
Figure 5
Figure 5
Axial mpMRI of a patient without PC detection at initial and repeat biopsy (Patient IV). (a) Initial mpMRI of Patient IV without PC detection at initial biopsy (PI-RADS lesion 3, T2-weighted image, the suspicious lesion is marked with an arrow); (b) moderate ADC reduction in the PI-RADS 3 lesion at initial biopsy; (c) discrete diffusion restriction of the PI-RADS 3 lesion in the high b-value image at initial biopsy; (d) repeat mpMRI of Patient IV without PC detection at repeat biopsy (PI-RADS score 2, T2-weighted image); (e) marked ADC reduction in the PI-RADS 2 lesion at repeat biopsy; (f) no signal enhancement of the PI-RADS 2 lesion in the high b-value image at repeat biopsy.
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