Abstract
The detection rate of prostate cancer (PCa) using traditional biopsy guided by transrectal ultrasound (TRUS) is not satisfactory. The aim of this study was to determine the utility of 3-Tesla (3-T) magnetic resonance imaging (MRI) prior to TRUS-guided prostate biopsy and to investigate which subgroup of patients had the most evident improvement in PCa detection rate. A total of 420 patients underwent 3-T MRI examination prior to the first prostate biopsy and the positions of suspicious areas were recorded respectively. TRUS-guided biopsy regimes included systematic 12-core biopsy and targeted biopsy identified by MRI. Patients were divided into subgroups according to their serum prostate-specific antigen (PSA) levels, PSA density (PSAD), prostate volume, TRUS findings and digital rectal examination (DRE) findings. The ability of MRI to improve the cancer detection rate was evaluated. The biopsy positive rate of PCa was 41.2% (173/420), and 41 of the 173 (23.7%) patients were detected only by targeted biopsy in the MRI-suspicious area. Compared with the systematic biopsy, the positive rate was significantly improved by the additional targeted biopsy (P=0.0033). The highest improvement of detection rate was observed in patients with a PSA level of 4–10 ng/ml, PSAD of 0.12–0.20 ng/ml2, prostate volume >50 ml, negative TRUS findings and negative DRE findings (P<0.05). Therefore, it is considered that 3-T MRI examination could improve the PCa detection rate on first biopsy, particularly in patients with a PSA level of 4–10 ng/ml, PSAD of 0.12–0.20 ng/ml2, prostate volume of >50 ml, negative TRUS findings and negative DRE findings.
Highlights
Transrectal ultrasound (TRUS)-guided biopsy is the most widely used method for the histological diagnosis of prostate cancer (PCa), which provides real-time imaging of the prostate at a relatively low cost
It has been hypothesized that TRUS-guided targeted biopsy in suspicious areas identified by magnetic resonance imaging (MRI) has the potential to obtain a high positive rate; few patients have been enrolled in studies to investigate this [10,11]
The increase in the cancer detection rate by targeted biopsy identified by MRI was 9.8% (41/420; P= 0.0033)
Summary
Transrectal ultrasound (TRUS)-guided biopsy is the most widely used method for the histological diagnosis of prostate cancer (PCa), which provides real-time imaging of the prostate at a relatively low cost. Additional targeted biopsy in suspicious areas identified by TRUS may improve detection rates, as the sensitivity of conventional TRUS for cancer lesions is relatively low [3,4]. There has been an increasing interest in the use of MRI for the diagnosis of PCa. MRI has been used to guide prostatic biopsy successfully, as first reported in 2000; MRI guidance is time-consuming and requires specific biopsy equipment [9]. It has been hypothesized that TRUS-guided targeted biopsy in suspicious areas identified by MRI has the potential to obtain a high positive rate; few patients have been enrolled in studies to investigate this [10,11]. To study whether MRI is able to increase the PCa detection rate generally, prospective research is required to compare the detection rate between patients undergoing conventional TRUS and those examined by MRI
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