MP67-05 FIRST ROUND OF TRANS-RECTAL TARGETED BIOPSIES WITH MAGNETIC RESONANCE IMAGING/ULTRASOUND-FUSION IMAGES VERSUS CONVENTIONAL ULTRASOUND-GUIDED BIOPSIES FOR THE DIAGNOSIS OF LOCALISED PROSTATE CANCER.

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prostate. TRUS-bx has limited sensitivity and specificity in PCa detection and repeated biopsy (re-biopsy)-strategies are therefore often necessary in patients with persistent suspicion of PCa after negative TRUS-bx due to the high false-negative rates. In addition, there is also a risk that the most pathological aggressive part of the tumour can be missed at TRUS-bx leading to an incorrect Gleason score and diagnosis. Scientific work support the growing use of multiparametric MRI (mp-MRI) as the most sensitive and specific imaging tool for detection of PCa where mp-MRI suspicious lesions can be targeted by biopsies towards the most aggressive part. METHODS: Patients scheduled for repeated biopsies due to persistent suspicion of PCa after standard TRUS-bx with negative findings were prospectively enrolled. Mp-MRI (T2W-, DWIand DCEimaging) was performed prior to re-biopsy. All identified lesions were scored by the ESUR guidelines, classified overall on a five-point scale according to the probability of clinically significant malignancy to be present and divided into 3 groups e low, moderate and high suspicion of PCa. All patients underwent systematic TRUS-bx (10 cores) and visual mp-MRI-targeted biopsies (mp-MRI-bx) under TRUS-guidance of any mp-MRI-suspicious lesion not hit on systematic TRUS-bx. RESULTS: 83 patients with median 2(1-5) prior negative TRUSBx and median PSA 11(2-97) underwent mp-MRI before re-biopsy. PCa was found in 39/83 (47%) patients. Mp-MRI identified at least one PCa positive lesion in all 39 patients with median 2 (0-5) identified lesions per patient. Biopsies positive for PCa correlated to suspicion of malignancy and Gleason score are shown in Table 1. 5 patients (13%) had cancer detected only on mp-MRI-bx (p1⁄40.025) and another 7 patients (21%) had an overall Gleason score upgrade (p1⁄40.037) based on the mp-MRI-bx. 37/39 cancer patients were classified as clinically significant according to the Epstein criteria (2004). CONCLUSIONS: Multiparametric MRI can improve the detection rate of clinically significant prostate cancer at repeated biopsy and allows for a more accurate Gleason grading.