MRI-Guided Biopsy of the Prostate Increases Diagnostic Performance in Men with Elevated or Increasing PSA Levels after Previous Negative TRUS Biopsies

Objectives: Repeatedly negative prostate biopsies in individuals with elevated prostate specific antigen (PSA) levels can be frustrating for both the patient and the urologist. This study was performed to investigate if magnetic resonance imaging (MRI)-guided transrectal biopsy increases diagnostic performance in individuals with elevated or increasing PSA levels after previous negative conventional transrectal ultrasound (TRUS)-guided biopsies. Methods: 27 consecutive men with a PSA >4 ng/ml and/or suspicious finding on digital rectal examination, suspicious MRI findings, and at least one prior negative prostate biopsy were included. Median age was 66 years (mean, 64.5 ± 6.8); median PSA was 10.2 ng/ml (mean, 11.3 ± 5.5). MRI-guided biopsy was performed with a closed unit at 1.5 Tesla, an MRI-compatible biopsy device, a needle guide, and a titanium double-shoot biopsy gun. Results: Median prostate volume was 37.4 cm³ (mean, 48.4 ± 31.5); median volume of tumor suspicious areas on T2w MR images was 0.83 cm³ (mean, 0.99 ± 0.78). The mean number of obtained cores per patient was 5.22 ± 1.45 (median, 5; range, 2-8). Prostate cancer was detected in 55.5% (15 of 27) of the men. MRI-guided biopsy could be performed without complications in all cases. Conclusion: According to our knowledge, this is the largest cohort of consecutive men to be examined by MRI-guided transrectal biopsy of the prostate in this setting. The method is safe, can be useful to select suspicious areas in the prostate, and has the potential to improve cancer detection rate in men with previous negative TRUS-biopsies.