Korean J Radiol.  2018 Aug;19(4):733-741. 10.3348/kjr.2018.19.4.733.

Yield of Repeat Targeted Direct in-Bore Magnetic Resonance-Guided Prostate Biopsy (MRGB) of the Same Lesions in Men Having a Prior Negative Targeted MRGB

• Venderink
• Jenniskens SF
• Michiel Sedelaar J
• Tamada T
• Fütterer

• KMID: 2413702
• DOI: http://doi.org/10.3348/kjr.2018.19.4.733

Abstract

OBJECTIVE
This study's purposes were to determine the yield of repeat direct in-bore magnetic resonance-guided prostate biopsy (MRGB) (MRGB-2) after the first one was found to be negative (MRGB-1), to correlate with clinical parameters, and to present the subgroup analyses of patients with positive repeat biopsies, despite having a negative initial biopsies.
MATERIALS AND METHODS
We retrospectively included patients with MRGB-2 after a negative MRGB-1 both between January 2006 and August 2016. This study included 62 patients (median age, 63 years; interquartile range [IQR], 58-66 years) with 75 sampled lesions during MRGB-2 left for analysis, and 63 lesions were resampled and 12 new lesions were sampled. Included patients had a prostate specific antigen (PSA) at MRGB-1 of 13 ng/mL (IQR, 5.8-20.0) and a PSA at MRGB-2 of 15 ng/mL (IQR, 9.0-22.5). All anonymized magnetic resonance imaging (MRI) data were retrospectively reassessed according to Prostate Imaging-Reporting and Data System version 2 by two radiologists. Images of MRGB were compared to determine whether the same prostate lesion was biopsied during MRGB-1 and MRGB-2. Descriptive statistics were utilized to determine the yield of clinically significant prostate cancer (csPCa) at MRGB-2. Gleason score of ≥ 3 + 4 was considered csPCa.
RESULTS
In 16/75 (21%) lesions csPCa was detected during MRGB-2. Of 63 resampled lesions, 13 (21%) harbored csPCa at MRGB-2. In two patients, csPCa was detected on repeat biopsy, while the volume of the lesion decreased between MRGB-1 and MRGB-2.
CONCLUSION
Patients could benefit from repeat biopsy after negative initial MRGB, especially in the case of increasing PSA values and persisting PCa suspicion in MRI. Further research is needed to establish predictors for positive repeat targeted biopsies.

Keyword

Prostate cancer; Prostate biopsy; MR-guided biopsy; Resampling; PI-RADS

MeSH Terms

Anonyms and Pseudonyms
Biopsy*
Humans
Information Systems
Magnetic Resonance Imaging
Male
Neoplasm Grading
Passive Cutaneous Anaphylaxis
Prostate*
Prostate-Specific Antigen
Prostatic Neoplasms
Retrospective Studies
Prostate-Specific Antigen

Figure

• 

  Fig. 1 Flowchart and in- and exclusion criteria of patients with repeat MRGB in our institution.cs = clinically significant, GS = Gleason score, MRGB = direct in-bore magnetic resonance imaging-guided biopsy, PCa = prostate cancer

• 

  Fig. 2 Example of decreasing lesion volume.68-year-old patient with PSA of 9.9 ng/mL having mpMRI-1 and subsequent MRGB-1 of lesion which was retrospectively scored PI-RADS 2 (A-D). Maximal lesion diameter was 15 mm. After 11 months, his PSA increased to 12.6 ng/mL, while lesion volume decreased 0.23 mL. Maximum lesion diameter was unchanged. At mpMRI-2, lesion still scored PI-RADS 2 (E-H). During MRGB-2 (Fig. 3) GS 3 + 5 csPCa was detected. (A, E) axial T2WI, (B, F) calculated axial ADC map, (C, G) axial DWI, (D, H) color map representing dynamic contrast enhancement images. ADC = apparent diffusion coefficient, DWI = diffusion-weighted images, mpMRI = multiparametric magnetic resonance imaging, PI-RADS = Prostate Imaging-Reporting and Data System, PSA = prostate specific antigen, T2WI = T2-weighted images

• 

  Fig. 3 Confirmation scan of biopsy needle during MRGB of patient represented in Figure 2.A, B. Respectively axial and sagittal images of MRGB-1. C, D. Respectively axial and sagittal images of MRGB-2. Needle was assumed to properly sample lesion.

• 

  Fig. 4 Example of decreasing lesion volume.52-year-old patient with PSA of 3.0 ng/mL having mpMRI-1 and subsequent MRGB-1 of lesion which was retrospectively scored PI-RADS 3 (A-D). Maximal lesion diameter was 9 mm. After 17 months, his PSA increased to 8.6 ng/mL and lesion volume increased 0.44 mL. Maximal lesion diameter increased to 13.5 mm. At mpMRI-2, lesion was scored PI-RADS 4 (E-H). During MRGB-2 (Fig. 5) GS 3 + 4 csPCa was detected. (A, E) axial T2WI, (B, F) calculated axial ADC map, (C, G) axial DWI, (D, H) color map representing dynamic contrast enhancement images.

• 

  Fig. 5 Confirmation scan of biopsy needle during MRGB of patient represented in Figure 4.A, B. Respectively axial and sagittal images of MRGB-1. C, D. Respectively axial and sagittal images of MRGB-2. Needle was assumed to properly sample lesion.

• 

  Fig. 6 Detection of csPCa correlated to time between MRGB-1 and MRGB-2 and to change in PSA.Triangles are representing lesions with csPCa at MRGB-2 and diamonds lesions without csPCa at MRGB-2.

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  Fig. 7 Timing of MRGB-1 correlated to number of lesions with csPCa detected during MRGB-2.In patients with repeat biopsy, MRGB-1 was never performed in year 2016.

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