Patient selection determines the prostate cancer yield of dynamic contrast‐enhanced magnetic resonance imaging‐guided transrectal biopsies in a closed 3‐Tesla scanner

Abstract

OBJECTIVE To evaluate the cancer yield of transrectal prostate biopsies in a 3‐T magnetic resonance imaging (MRI) scanner in patients with elevated prostate specific antigen (PSA) levels and recent negative transrectal ultrasonography (TRUS)‐guided prostate biopsies. PATIENTS AND METHODS Between July 2004 and November 2005, patients with at least one previous negative prostate biopsy within the previous 12 months had MRI‐guided biopsy of the prostate in a 3‐T MRI scanner. Patients with previous positive biopsies for cancer were excluded. Target selection was based on T2‐weighted imaging and dynamic contrast‐enhanced (DCE) imaging studies. RESULTS Thirteen patients were eligible; their median (range) age was 61 (47–74) years and PSA value 4.90 (1.3–12.3) ng/mL. Most patients had one previous negative biopsy (range 1–4). Four patients had a family history of prostate cancer. There were 37 distinct targets based on T2‐weighted imaging. Fifteen of 16 distinct DCE abnormalities were co‐localized with a target based on T2‐weighted imaging. Despite this correlation, only one of 13 patients had a directed biopsy positive for cancer. Including systematic biopsies, two of 13 patients had a biopsy positive for prostate cancer. One patient had prostate intraepithelial neoplasia and one had atypical glands in the specimen. CONCLUSION The prostate‐cancer yield of transrectal biopsies in a 3‐T MRI scanner, among patients with recent negative TRUS‐guided prostate biopsies, is similar to repeat systematic TRUS‐guided biopsy. DCE correlates with T2‐imaging but does not appear to improve prostate cancer yield in this population.