2204 IS MRI WITH DIFFUSION WEIGHTED IMAGING EFFECTIVE IN DETECTING PROSTATE CANCER IN MEN WITH PREVIOUS NEGATIVE BIOPSIES?

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening (V)1 Apr 20132204 IS MRI WITH DIFFUSION WEIGHTED IMAGING EFFECTIVE IN DETECTING PROSTATE CANCER IN MEN WITH PREVIOUS NEGATIVE BIOPSIES? Matthew Young, Ryan Levey, James Rosoff, Josh Smith, George Ghareeb, Brian Lane, Andrew Hardie, Thomas Keane, and Stephen Savage Matthew YoungMatthew Young Charleston, SC More articles by this author , Ryan LeveyRyan Levey Charleston, SC More articles by this author , James RosoffJames Rosoff Charleston, SC More articles by this author , Josh SmithJosh Smith Grand Rapids, MI More articles by this author , George GhareebGeorge Ghareeb Grand Rapids, MI More articles by this author , Brian LaneBrian Lane Grand Rapids, Macedonia More articles by this author , Andrew HardieAndrew Hardie Charlestons, SC More articles by this author , Thomas KeaneThomas Keane Charleston, SC More articles by this author , and Stephen SavageStephen Savage Charleston, SC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2113AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate biopsy is typically triggered by elevated serum prostate specific antigen (PSA) or abnormal digital rectal examination (DRE). However, the false negative rate of initial biopsy can be as high as 35%. A diagnostic dilemma exists in those individuals with continued clinical suspicion of cancer and negative initial biopsy. These individuals have often been subjected to repeat biopsy which may have significant morbidity, including peri and post-procedural discomfort, infection, and psychological stress. We examined whether pelvic MRI with gadolinium and diffusion-weighted imaging is an effective adjunct in identifying prostate cancer in patients who have had previous negative prostate biopsy. METHODS After obtaining IRB approval, a retrospective review from two institutions was performed to identify patients who have had an MRI of the prostate after a previous negative prostate needle biopsy. A total of 76 patients were identified. Multi-parametric, phased array coil MRI was performed of the prostate. Image sequences obtained included high resolution T1 and T2-weighted, diffusion-weighted and dynamic pre and post contrast sequences. Patient charts were reviewed for biopsy results and techniques, PSA dynamics, age, and physical exam. RESULTS 76 patients with a median of 2 previous negative biopsies (range 1-5) were evaluated, with 36 having suspicious findings on MRI, of whom 32 underwent biopsy. 8 patients had pathologically-proven prostate cancer, 5 from the anterior gland, 1 from the apex, and 2 from the transition zone. For patients with suspicious findings on MRI, those with subsequent negative biopsies had a significantly lower PSA density than those with positive biopsies (0.15ng/ml/cc vs 0.31 ng/ml/cc; p =0.004), with a median prostate volume of 56.5 cc. No significant difference in PSA velocity (0.058 vs 0.051 ng/ml/year) or doubling time (7.4 VS 7.8 years) was found. CONCLUSIONS The exact role of MRI in patients with previous negative biopsies remains controversial. Detection rates using MRI following at least one negative biopsy vary from 38-52% in multiple studies. Our results suggest PSA density, in addition to MRI findings, may improve the sensitivity of MRI and help guide physicians in management for patients with persistently elevated PSA and initial negative prostate biopsies. In addition, MRI findings may help direct biopsies to regions not typically biopsied during a standard 12 core office biopsy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e903-e904 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Young Charleston, SC More articles by this author Ryan Levey Charleston, SC More articles by this author James Rosoff Charleston, SC More articles by this author Josh Smith Grand Rapids, MI More articles by this author George Ghareeb Grand Rapids, MI More articles by this author Brian Lane Grand Rapids, Macedonia More articles by this author Andrew Hardie Charlestons, SC More articles by this author Thomas Keane Charleston, SC More articles by this author Stephen Savage Charleston, SC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...