Skip to main content

Advertisement

SpringerLink
Log in

In-bore magnetic resonance-guided transrectal biopsy for the detection of clinically significant prostate cancer

  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine the safety and efficacy of in-bore magnetic resonance-guided prostate biopsy (MRGB) for detection of clinically significant disease (CSD) in untreated men with known or suspected prostate cancer (PCa).

Methods

512 patients underwent multiparametric magnetic resonance imaging (Mp-MRI) followed by MRGB at one of three centers in this IRB-approved, HIPAA-compliant, retrospective study. Exclusion criteria were prior prostate cancer therapy and incomplete Mp-MRI (n = 51). Patients (n = 461) were analyzed in two subcohorts: no prior PCa (NP) (n = 381) and active surveillance (AS) (n = 80). Detection rates of PCa and CSD (Gleason Score ≥3 + 4) were calculated and compared among subcohorts and by Mp-MRI assessment grade. Logistic regression was performed to identify predictors for detection of PCa and CSD.

Results

Mean patient age was 66 years, median prostate-specific antigen (PSA) was 7.5 ng/mL, and median prostate volume was 54 cc. A mean of 1.7 targets was sampled per gland. Significant adverse events (urosepsis and hematuria with obstruction) occurred in 1% (5/461). Overall PCa detection rates were 51% per patient (233/461) and 37% per lesion (282/757). 65% (151/233) of men with detected PCa had CSD. Per-patient PCa detection rates in the NP and AS subcohorts were 47% (178/381) and 69% (55/80), respectively, significantly higher in the AS group (p < 0.001). CSD was detected in 10% (47/451), 43% (96/225) and 84% (68/81) of lesions with Mp-MRI assessment grades of 3, 4, and 5, respectively. Older age, higher PSA, and lower prostate volume predicted MRGB detection of CSD (OR 1.07 and p = 0.003, OR 1.1 and p = 0.014, and OR 0.98 and p = 0.032, respectively).

Conclusions

In-bore MRGB is safe and high yield for detection of CSD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Ward E, et al. (2009) Cancer statistics, 2009. CA Cancer J Clin. 59(4):225–249

    Article  PubMed  Google Scholar 

  2. Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM (2011) Complications after prostate biopsy: data from SEER-Medicare. J Urol. 186(5):1830–1834

    Article  PubMed  Google Scholar 

  3. Hodge KK, McNeal JE, Stamey TA (1989) Ultrasound guided transrectal core biopsies of the palpably abnormal prostate. J Urol. 142(1):66–70

    CAS  PubMed  Google Scholar 

  4. Djavan B, Ravery V, Zlotta A, et al. (2001) Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J Urol. 166(5):1679–1683

    Article  CAS  PubMed  Google Scholar 

  5. Dall’Era MA, Cooperberg MR, Chan JM, et al. (2008) Active surveillance for early-stage prostate cancer: review of the current literature. Cancer. 112(8):1650–1659

    Article  PubMed  Google Scholar 

  6. Nam RK, Saskin R, Lee Y, et al. (2013) Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol. 189(1 Suppl):S12–S17 (discussion S7–8)

    Article  PubMed  Google Scholar 

  7. Hegde JV, Mulkern RV, Panych LP, et al. (2013) Multiparametric MRI of prostate cancer: an update on state-of-the-art techniques and their performance in detecting and localizing prostate cancer. J Magn Reson Imaging. 37(5):1035–1054

    Article  PubMed  PubMed Central  Google Scholar 

  8. Shukla-Dave A, Hricak H, Kattan MW, et al. (2007) The utility of magnetic resonance imaging and spectroscopy for predicting insignificant prostate cancer: an initial analysis. BJU Int. 99(4):786–793

    Article  CAS  PubMed  Google Scholar 

  9. Kurhanewicz J, Vigneron D, Carroll P, Coakley F (2008) Multiparametric magnetic resonance imaging in prostate cancer: present and future. Curr Opin Urol. 18(1):71

    Article  PubMed  PubMed Central  Google Scholar 

  10. Villers A, Puech P, Mouton D, et al. (2006) Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. J Urol. 176(6 Pt 1):2432–2437

    Article  PubMed  Google Scholar 

  11. Fütterer JJ, Heijmink SW, Scheenen TW, et al. (2006) Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology. 241(2):449–458

    Article  PubMed  Google Scholar 

  12. Haker SJ, Mulkern RV, Roebuck JR, et al. (2005) Magnetic resonance-guided prostate interventions. Top Magn Reson Imaging. 16(5):355–368

    Article  PubMed  Google Scholar 

  13. Beyersdorff D, Winkel A, Hamm B, et al. (2005) MR imaging-guided prostate biopsy with a closed MR unit at 1.5 T: initial results. Radiology. 234(2):576–581

    Article  PubMed  Google Scholar 

  14. Pinto PA, Chung PH, Rastinehad AR, et al. (2011) Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. J Urol. 186(4):1281–1285

    Article  PubMed  PubMed Central  Google Scholar 

  15. Marks L, Young S, Natarajan S (2013) MRI-ultrasound fusion for guidance of targeted prostate biopsy. Curr Opin Urol. 23(1):43–50

    Article  PubMed  PubMed Central  Google Scholar 

  16. Natarajan S, Marks LS, Margolis DJ, et al. (2011) Clinical application of a 3D ultrasound-guided prostate biopsy system. Urol Oncol. 29(3):334–342

    Article  PubMed  PubMed Central  Google Scholar 

  17. Siddiqui MM, Rais-Bahrami S, Turkbey B, et al. (2015) Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA. 313(4):390–397

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kasivisvanathan V, Dufour R, Moore CM, et al. (2013) Transperineal magnetic resonance image targeted prostate biopsy versus transperineal template prostate biopsy in the detection of clinically significant prostate cancer. J Urol. 189(3):860–866

    Article  PubMed  Google Scholar 

  19. Nelson AW, Harvey RC, Parker RA, et al. (2013) Repeat prostate biopsy strategies after initial negative biopsy: meta-regression comparing cancer detection of transperineal, transrectal saturation and MRI guided biopsy. PLoS One. 8(2):e57480

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Valerio M, Donaldson I, Emberton M, et al. (2014) Detection of clinically significant prostate cancer using magnetic resonance imaging-ultrasound fusion targeted biopsy: a systematic review. Eur Urol. 68:8–19

    Article  PubMed  Google Scholar 

  21. Abdi H, Pourmalek F, Zargar H, et al. (2015) Multiparametric magnetic resonance imaging enhances detection of significant tumor in patients on active surveillance for prostate cancer. Urology. 85(2):423–428

    Article  PubMed  Google Scholar 

  22. Hu JC, Chang E, Natarajan S, et al. (2014) Targeted prostate biopsy in select men for active surveillance: do the Epstein criteria still apply? J Urol. 192(2):385–390

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hoeks CM, Somford DM, van Oort IM, et al. (2014) Value of 3-T multiparametric magnetic resonance imaging and magnetic resonance-guided biopsy for early risk restratification in active surveillance of low-risk prostate cancer: a prospective multicenter cohort study. Invest Radiol. 49(3):165–172

    Article  PubMed  Google Scholar 

  24. Weinreb JC, Barentsz JO, Choyke PL, et al. (2015) PI-RADS prostate imaging—reporting and data system: 2015, Version 2. Eur Urol. 69:16–40

    Article  PubMed  Google Scholar 

  25. Barentsz JO, Richenberg J, Clements R, et al. (2012) ESUR prostate MR guidelines 2012. Eur Radiol. 22(4):746–757

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sonn GA, Natarajan S, Margolis DJ, et al. (2013) Targeted biopsy in the detection of prostate cancer using an office based magnetic resonance ultrasound fusion device. J Urol. 189(1):86–91

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bastian PJ, Mangold LA, Epstein JI, Partin AW (2004) Characteristics of insignificant clinical T1c prostate tumors. A contemporary analysis. Cancer. 101(9):2001–2005

    PubMed  Google Scholar 

  28. Partin AW, Yoo J, Carter HB, et al. (1993) The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J Urol. 150(1):110–114

    CAS  PubMed  Google Scholar 

  29. Ahmed HU, Hu Y, Carter T, et al. (2011) Characterizing clinically significant prostate cancer using template prostate mapping biopsy. J Urol. 186(2):458–464

    Article  PubMed  Google Scholar 

  30. D’Amico AV, Whittington R, Malkowicz SB, et al. (2002) Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. Cancer. 95(2):281

    Article  PubMed  Google Scholar 

  31. Moore CM, Kasivisvanathan V, Eggener S, et al. (2013) Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. Eur Urol. 64(4):544–552

    Article  PubMed  Google Scholar 

  32. Schouten MG, Hoeks CM, Bomers JG, et al. (2015) Location of prostate cancers determined by multiparametric and mri-guided biopsy in patients with elevated prostate-specific antigen level and at least one negative transrectal ultrasound-guided biopsy. AJR Am J Roentgenol. 205(1):57–63

    Article  PubMed  Google Scholar 

  33. Franiel T, Stephan C, Erbersdobler A, et al. (2011) Areas suspicious for prostate cancer: MR-guided biopsy in patients with at least one transrectal US-guided biopsy with a negative finding–multiparametric MR imaging for detection and biopsy planning. Radiology. 259(1):162–172

    Article  PubMed  Google Scholar 

  34. Hambrock T, Somford DM, Hoeks C, et al. (2010) Magnetic resonance imaging guided prostate biopsy in men with repeat negative biopsies and increased prostate specific antigen. J Urol. 183(2):520–527

    Article  CAS  PubMed  Google Scholar 

  35. de Rooij M, Crienen S, Witjes JA, et al. (2014) Cost-effectiveness of magnetic resonance (MR) imaging and MR-guided targeted biopsy versus systematic transrectal ultrasound-guided biopsy in diagnosing prostate cancer: a modelling study from a health care perspective. Eur Urol. 66(3):430–436

    Article  PubMed  Google Scholar 

  36. Roethke M, Anastasiadis AG, Lichy M, et al. (2012) MRI-guided prostate biopsy detects clinically significant cancer: analysis of a cohort of 100 patients after previous negative TRUS biopsy. World J Urol. 30(2):213–218

    Article  CAS  PubMed  Google Scholar 

  37. Anastasiadis AG, Lichy MP, Nagele U, et al. (2006) MRI-guided biopsy of the prostate increases diagnostic performance in men with elevated or increasing PSA levels after previous negative TRUS biopsies. Eur Urol. 50(4):738–748

    Article  CAS  PubMed  Google Scholar 

  38. Engelhard K, Hollenbach HP, Kiefer B, et al. (2006) Prostate biopsy in the supine position in a standard 1.5-T scanner under real time MR-imaging control using a MR-compatible endorectal biopsy device. Eur Radiol. 16(6):1237–1243

    Article  CAS  PubMed  Google Scholar 

  39. Hoeks CM, Schouten MG, Bomers JG, et al. (2012) Three-Tesla magnetic resonance-guided prostate biopsy in men with increased prostate-specific antigen and repeated, negative, random, systematic, transrectal ultrasound biopsies: detection of clinically significant prostate cancers. Eur Urol. 62(5):902–909

    Article  PubMed  Google Scholar 

  40. Penzkofer T, Tuncali K, Fedorov A, et al. (2015) Transperineal in-bore 3-T MR imaging-guided prostate biopsy: a prospective clinical observational study. Radiology. 274(1):170–180

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza Suite 1638, Los Angeles, CA, 90095, USA

    Ely R. Felker, Stephanie A. Lee-Felker, Daniel J. Margolis, David S. Lu, Hyun J. Kim & Steven S. Raman

  2. Desert Medical Imaging, 1133 N Palm Canyon Dr. Suite B, Palm Springs, CA, 92262, USA

    John Feller, Stuart May & Bernadette Greenwood

  3. Rolling Oaks Radiology, 415 Rolling Oaks Dr., Thousand Oaks, CA, 91361, USA

    Robert Princenthal & Martin Cohen

  4. Department of Pathology, David Geffen School of Medicine, 10833 Le Conte Ave., Suite 13-229 CHS, Los Angeles, CA, 90095, USA

    Jiaoti Huang

  5. Newport Urologic Oncology, 1525 Superior Avenue #210, Newport Beach, CA, 92663, USA

    Jeffrey Yoshida

Authors
  1. Ely R. Felker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephanie A. Lee-Felker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Feller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel J. Margolis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David S. Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert Princenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stuart May
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Martin Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jiaoti Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jeffrey Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Bernadette Greenwood
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hyun J. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Steven S. Raman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ely R. Felker.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this retrospective study, formal consent is not required.

Informed consent

This retrospective study was approved by our institutional review board with a waiver of informed consent and was compliant with the 1996 Health Insurance Portability and Accountability Act.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Felker, E.R., Lee-Felker, S.A., Feller, J. et al. In-bore magnetic resonance-guided transrectal biopsy for the detection of clinically significant prostate cancer. Abdom Radiol 41, 954–962 (2016). https://doi.org/10.1007/s00261-016-0750-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-016-0750-7

Keywords

Search

Navigation