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Why and Where do We Miss Significant Prostate Cancer with Multi-parametric Magnetic Resonance Imaging followed by Magnetic Resonance-guided and Transrectal Ultrasound-guided Biopsy in Biopsy-naïve Men?

European Urology, Volume 71, Issue 6, June 2017, Pages 896 - 903

Abstract

Background

Knowledge of significant prostate (sPCa) locations being missed with magnetic resonance (MR)- and transrectal ultrasound (TRUS)-guided biopsy (Bx) may help to improve these techniques.

Objective

To identify the location of sPCa lesions being missed with MR- and TRUS-Bx.

Design, setting, and participants

In a referral center, 223 consecutive Bx-naive men with elevated prostate specific antigen level and/or abnormal digital rectal examination were included. Histopathologically-proven cancer locations, Gleason score, and tumor length were determined.

Intervention

All patients underwent multi-parametric MRI and 12-core systematic TRUS-Bx. MR-Bx was performed in all patients with suspicion of PCa on multi-parametric MRI (n = 142).

Outcome measurements and statistical analysis

Cancer locations were compared between MR- and TRUS-Bx. Proportions were expressed as percentages, and the corresponding 95% confidence intervals were calculated.

Results and limitations

In total, 191 lesions were found in 108 patients with sPCa. From these lesion 74% (141/191) were defined as sPCa on either MR- or TRUS-Bx. MR-Bx detected 74% (105/141) of these lesions and 61% (86/141) with TRUS-Bx. TRUS-Bx detected more lesions compared with MR-Bx (140 vs 109). However, these lesions were often low risk (39%). Significant lesions missed with MR-Bx most often had involvement of dorsolateral (58%) and apical (37%) segments and missed segments with TRUS-Bx were located anteriorly (79%), anterior midprostate (50%), and anterior apex (23%).

Conclusions

Both techniques have difficulties in detecting apical lesions. MR-Bx most often missed cancer with involvement of the dorsolateral part (58%) and TRUS-Bx with involvement of the anterior part (79%).

Patient summary

Both biopsy techniques miss cancer in specific locations within the prostate. Identification of these lesions may help to improve these techniques.

Take Home Message

Both magnetic resonance- and transrectal ultrasound-guided biopsy techniques have difficulties in detecting apical lesions. Magnetic resonance-guided biopsy most often missed cancer with involvement of the dorsolateral part (58%) and transrectal ultrasound-guided biopsy with involvement of the anterior part (79%).

Keywords: MRI, Prostate, Cancer, Biopsy, Location.

Footnotes

a Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

b Department of Urology, The Wesley Hospital, Brisbane, Australia

Corresponding author. Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Geert Grooteplein 10, Nijmegen 6525 GA, The Netherlands. Tel. +31 24 365 22 79.