Relationship between Prebiopsy Multiparametric Magnetic Resonance Imaging (MRI), Biopsy Indication, and MRI-ultrasound Fusion-targeted Prostate Biopsy Outcomes

Xiaosong Meng, Andrew B. Rosenkrantz, Neil Mendhiratta, Michael Fenstermaker, Richard Huang, James S. Wysock, Marc A. Bjurlin, Susan Marshall, Fang Ming Deng, Ming Zhou, Jonathan Melamed, William C. Huang, Herbert Lepor, Samir S. Taneja

Research output: Contribution to journalArticlepeer-review


Background Increasing evidence supports the use of magnetic resonance imaging (MRI)-ultrasound fusion-targeted prostate biopsy (MRF-TB) to improve the detection of clinically significant prostate cancer (PCa) while limiting detection of indolent disease compared to systematic 12-core biopsy (SB). Objective To compare MRF-TB and SB results and investigate the relationship between biopsy outcomes and prebiopsy MRI. Design, setting, and participants Retrospective analysis of a prospectively acquired cohort of men presenting for prostate biopsy over a 26-mo period. A total of 601 of 803 consecutively eligible men were included. Interventions All men were offered prebiopsy MRI and assigned a maximum MRI suspicion score (mSS). Men with an MRI abnormality underwent combined MRF-TB and SB. Outcomes Detection rates for all PCa and high-grade PCa (Gleason score [GS] ≥7) were compared using the McNemar test. Results and limitations MRF-TB detected fewer GS 6 PCas (75 vs 121; p < 0.001) and more GS ≥7 PCas (158 vs 117; p < 0.001) than SB. Higher mSS was associated with higher detection of GS ≥7 PCa (p < 0.001) but was not correlated with detection of GS 6 PCa. Prediction of GS ≥7 disease by mSS varied according to biopsy history. Compared to SB, MRF-TB identified more GS ≥7 PCas in men with no prior biopsy (88 vs 72; p = 0.012), in men with a prior negative biopsy (28 vs 16; p = 0.010), and in men with a prior cancer diagnosis (42 vs 29; p = 0.043). MRF-TB detected fewer GS 6 PCas in men with no prior biopsy (32 vs 60; p < 0.001) and men with prior cancer (30 vs 46; p = 0.034). Limitations include the retrospective design and the potential for selection bias given a referral population. Conclusions MRF-TB detects more high-grade PCas than SB while limiting detection of GS 6 PCa in men presenting for prostate biopsy. These findings suggest that prebiopsy multiparametric MRI and MRF-TB should be considered for all men undergoing prostate biopsy. In addition, mSS in conjunction with biopsy indications may ultimately help in identifying men at low risk of high-grade cancer for whom prostate biopsy may not be warranted. Patient summary We examined how magnetic resonance imaging (MRI)-targeted prostate biopsy compares to traditional systematic biopsy in detecting prostate cancer among men with suspicion of prostate cancer. We found that MRI-targeted biopsy detected more high-grade cancers than systematic biopsy, and that MRI performed before biopsy can predict the risk of high-grade cancer.

Original languageEnglish (US)
Pages (from-to)512-517
Number of pages6
JournalEuropean Urology
Issue number3
StatePublished - Mar 1 2016


  • Magnetic resonance imaging-targeted prostate biopsy
  • Magnetic resonance imaging-ultrasound fusion
  • Prostate biopsy
  • Prostate cancer
  • Prostate magnetic resonance imaging

ASJC Scopus subject areas

  • Urology


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