Objectives: We compared the transperineal MRI/ultrasound-fusion biopsy (fusPbx) to transrectal systematic biopsy (sysPbx) in patients with previously negative biopsy and investigated the prediction of tumour aggressiveness with regard to radical prostatectomy (RP) specimen. Material and Methods: A total of 710 patients underwent multiparametric magnetic resonance imaging (mpMRI), which was evaluated in accordance with Prostate Imaging Reporting and Data System (PI-RADS). The maximum PI-RADS (maxPI-RADS) was defined as the highest PI-RADS of all lesions detected in mpMRI. In case of proven prostate cancer (PCa) and performed RP, tumour grading of the biopsy specimen was compared to that of the RP. Significant PCa (csPCa) was defined according to Epstein criteria. Results: Overall, scPCa was detected in 40% of patients. The detection rate of scPCa was 33% for fusPbx and 25% for sysPbx alone (p < 0.005). Patients with a maxPI-RADS ≥3 and a prostate specific antigen (PSA)-density ≥0.2 ng/mL2 harboured more csPCa than those with a PSA-density < 0.2 ng/mL2 (41% [33/81] vs. 20% [48/248]; p < 0.001). Compared to the RP specimen (n = 140), the concordance of tumour grading was 48% (γ = 0.57), 36% (γ = 0.31) and 54% (γ = 0.6) in fusPbx, sysPbx and comPbx, respectively. Conclusions: The combination of fusPbx and sysPbx outperforms both biopsy modalities in patients with re-biopsy. Additionally, the PSA-density may represent a predictor for csPCa in patients with maxPI-RADS ≥3.

Keywords:
Magnetic resonance imaging/Ultrasound-fusion biopsy , Prostate cancer, Multiparametric magnetic resonance imaging, Systematic biopsy, Previous negative biopsy, Prostatectomy, Prediction
1.
Haider MA, Yao X, Loblaw A, Finelli A: Multiparametric magnetic resonance imaging in the diagnosis of prostate cancer: a systematic review. Clin Oncol 2016; 28: 550–567.
2.
Wegelin O, van Melick HH, Hooft L, et al: Comparing three different techniques for magnetic resonance imaging-targeted prostate biopsies: a systematic review of in-bore versus magnetic resonance imaging-transrectal ultrasound fusion versus cognitive registration. Is there a preferred technique? Eur Urol 2017; 71: 517–531.
3.
Hansen NL, Kesch C, Barrett T, et al: Multicentre evaluation of targeted and systematic biopsies using magnetic resonance and ultrasound image-fusion guided transperineal prostate biopsy in patients with a previous negative biopsy. BJU Int 2017; 120: 631–638.
4.
Meng X, Rosenkrantz AB, Mendhiratta N, et al: Relationship between prebiopsy multiparametric magnetic resonance imaging (MRI), biopsy indication, and MRI-ultrasound fusion-targeted prostate biopsy outcomes. Eur Urol 2016; 69: 512–517.
5.
Siddiqui MM, Truong H, Rais-Bahrami S, et al: Clinical implications of a multiparametric magnetic resonance imaging based nomogram applied to prostate cancer active surveillance. J Urol 2015; 193: 1943–1949.
6.
Sonn GA, Chang E, Natarajan S, et al: Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen. Eur Urol 2014; 65: 809–815.
7.
Graham J, Kirkbride P, Cann K, Hasler E, Prettyjohns M: Prostate cancer: summary of updated NICE guidance. BMJ 2014; 348:f7524.
8.
Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft DK, AWMF): Konsultationsfassung: Interdisziplinäre Leitlinie der Qualität S3 zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms, Lang- version 4.0, 2016 AWMF Registernummer: 043/022OL, http://leitlinienprogramm- onkologie.de/Prostatakarzinom.58.0.html.
9.
Rosenkrantz AB, Verma S, Choyke P, et al: Prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a prior negative biopsy: a consensus statement by AUA and SAR. J Urol 2016; 196: 1613–1618.
10.
Mottet N, Bellmunt J, Bolla M, et al: EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 2017; 71: 618–629.
11.
Ahmed HU, El-Shater Bosaily A, Brown LC, et al: Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017; 389: 815–822.
12.
Kasivisvanathan V, Rannikko AS, Borghi M, et al: MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 2018; 378: 1767–1777.
13.
Boesen L, Norgaard N, Logager V, Balslev I, Thomsen HS: A prospective comparison of selective multiparametric magnetic resonance imaging fusion-targeted and systematic transrectal ultrasound-guided biopsies for detecting prostate cancer in men undergoing repeated biopsies. Urol Int 2017; 99: 384–391.
14.
Junker D, Schafer G, Heidegger I, et al: Multiparametric magnetic resonance imaging/transrectal ultrasound fusion targeted biopsy of the prostate: preliminary results of a prospective single-centre study. Urol Int 2015; 94: 313–318.
15.
Kesch C, Radtke JP, Popeneciu IV, et al: TOP: prospective evaluation of a volume based, computer assisted method for transperineal optimized prostate biopsy. Urol Int 2017; 99: 149–155.
16.
Baco E, Ukimura O, Rud E, et al: Magnetic resonance imaging-transectal ultrasound image-fusion biopsies accurately characterize the index tumor: correlation with step-sectioned radical prostatectomy specimens in 135 patients. Eur Urol 2015; 67: 787–794.
17.
Borkowetz A, Platzek I, Toma M, et al: Direct comparison of multiparametric magnetic resonance imaging (MRI) results with final histopathology in patients with proven prostate cancer in MRI/ultrasonography-fusion biopsy. BJU Int 2016; 118: 213–220.
18.
Le JD, Stephenson S, Brugger M, et al: Magnetic resonance imaging-ultrasound fusion biopsy for prediction of final prostate pathology. J Urol 2014; 192: 1367–1373.
19.
Radtke JP, Schwab C, Wolf MB, et al: Multiparametric magnetic resonance imaging (MRI) and MRI-transrectal ultrasound fusion biopsy for index tumor detection: correlation with radical prostatectomy specimen. Eur Urol 2016; 70: 846–853.
20.
Barentsz JO, Richenberg J, Clements R, et al: ESUR prostate MR guidelines 2012. Eur Radiol 2012; 22: 746–757.
21.
Barentsz JO, Weinreb JC, Verma S, et al: Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imaging and recommendations for use. Eur Urol 2016; 69: 41–49.
22.
Weinreb JC, Barentsz JO, Choyke PL, et al: PI-RADS prostate imaging – reporting and data system: 2015, version 2. Eur Urol 2016; 69: 16–40.
23.
Borkowetz A, Platzek I, Toma M, et al: Comparison of systematic transrectal biopsy to transperineal magnetic resonance imaging/ultrasound-fusion biopsy for the diagnosis of prostate cancer. BJU Int 2015; 116: 873–879.
24.
Mendhiratta N, Meng X, Rosenkrantz AB, et al: Prebiopsy MRI and MRI-ultrasound fusion-targeted prostate biopsy in men with previous negative biopsies: impact on repeat biopsy strategies. Urology 2015; 86: 1192–1198.
25.
Pokorny MR, de Rooij M, Duncan E, et al: Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy versus magnetic resonance (MR) imaging with subsequent MR-guided biopsy in men without previous prostate biopsies. Eur Urol 2014; 66: 22–29.
26.
Pepe P, Garufi A, Priolo G, Pennisi M: Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evaluation of men in active surveillance? World J Urol 2016; 34: 1249–1253.
27.
Filson CP, Natarajan S, Margolis DJ, et al: Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: the role of systematic and targeted biopsies. Cancer 2016; 122: 884–892.
28.
Cash H, Maxeiner A, Stephan C, et al: The detection of significant prostate cancer is correlated with the Prostate Imaging Reporting and Data System (PI-RADS) in MRI/transrectal ultrasound fusion biopsy. World J Urol 2016; 34: 525–532.
29.
Borkowetz A, Platzek I, Toma M, et al: Evaluation of prostate imaging reporting and data system classification in the prediction of tumor aggressiveness in targeted magnetic resonance imaging/ultrasound-fusion biopsy. Urol Int 2017; 99: 177–185.
30.
Gomez Rivas J, Giganti F, Alvarez-Maestro M, et al: Prostate indeterminate lesions on magnetic resonance imaging-biopsy versus surveillance: a literature review. Eur Urol Focus 2018;pii:S2405-4569(18)30074-9.
31.
Truong M, Frye TP: Magnetic resonance imaging detection of prostate cancer in men with previous negative prostate biopsy. Transl Androl Urol 2017; 6: 424–431.
32.
Chelluri R, Kilchevsky A, George AK, et al: Prostate cancer diagnosis on repeat magnetic resonance imaging-transrectal ultrasound fusion biopsy of benign lesions: recommendations for repeat sampling. J Urol 2016; 196: 62–67.
33.
Costa DN, Yuan Q, Xi Y, et al: Comparison of prostate cancer detection at 3-T MRI with and without an endorectal coil: a prospective, paired-patient study. Urol Oncol 2016; 34: 255.e7–55.e13.
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2018
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