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Multicentre evaluation of magnetic resonance imaging supported transperineal prostate biopsy in biopsy-naïve men with suspicion of prostate cancer.

  • Hansen, Nienke L1
  • Barrett, Tristan1, 2
  • Kesch, Claudia3
  • Pepdjonovic, Lana4
  • Bonekamp, David5
  • O'Sullivan, Richard6
  • Distler, Florian3
  • Warren, Anne1, 7
  • Samel, Christina8
  • Hadaschik, Boris3
  • Grummet, Jeremy4
  • Kastner, Christof1, 9
  • 1 CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
  • 2 Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
  • 3 Department of Urology, University Hospital Heidelberg, Heidelberg, Germany. , (Germany)
  • 4 Australian Urology Associates and Department of Surgery, Central Clinical School, Monash University, Melbourne, Vic., Australia. , (Australia)
  • 5 Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. , (Germany)
  • 6 Healthcare Imaging and Monash University, Melbourne, Vic., Australia. , (Australia)
  • 7 Department of Pathology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
  • 8 Institute of Medical Statistics, Informatics and Epidemiology, University Hospital Cologne, Cologne, Germany. , (Germany)
  • 9 Department of Urology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
Published Article
British Journal of Urology
Wiley (Blackwell Publishing)
Publication Date
Jul 01, 2018
DOI: 10.1111/bju.14049
PMID: 29024425


To analyse the detection rates of primary magnetic resonance imaging (MRI)-fusion transperineal prostate biopsy using combined targeted and systematic core distribution in three tertiary referral centres. In this multicentre, prospective outcome study, 807 consecutive biopsy-naïve patients underwent MRI-guided transperineal prostate biopsy, as the first diagnostic intervention, between 10/2012 and 05/2016. MRI was reported following the Prostate Imaging-Reporting and Data System (PI-RADS) criteria. In all, 236 patients had 18-24 systematic transperineal biopsies only, and 571 patients underwent additional targeted biopsies either by MRI-fusion or cognitive targeting if PI-RADS ≥3 lesions were present. Detection rates for any and Gleason score 7-10 cancer in targeted and overall biopsy were calculated and predictive values were calculated for different PI-RADS and PSA density (PSAD) groups. Cancer was detected in 68% of the patients (546/807) and Gleason score 7-10 cancer in 49% (392/807). The negative predictive value of 236 PI-RADS 1-2 MRI in combination with PSAD of <0.1 ng/mL/mL for Gleason score 7-10 was 0.91 (95% confidence interval ± 0.07, 8% of study population). In 418 patients with PI-RADS 4-5 lesions using targeted plus systematic biopsies, the cancer detection rate of Gleason score 7-10 was significantly higher at 71% vs 59% and 61% with either approach alone (P < 0.001). For 153 PI-RADS 3 lesions, the detection rate was 31% with no significant difference to systematic biopsies with 27% (P > 0.05). Limitations include variability of multiparametric MRI (mpMRI) reading and Gleason grading. MRI-based transperineal biopsy performed at high-volume tertiary care centres with a significant experience of prostate mpMRI and image-guided targeted biopsies yielded high detection rates of Gleason score 7-10 cancer. Prostate biopsies may not be needed for men with low PSAD and an unsuspicious MRI. In patients with high probability lesions, combined targeted and systematic biopsies are recommended. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

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