MRI in-bore biopsy following MRI/US fusion-guided biopsy in patients with persistent suspicion of clinically significant prostate cancer

• Published in: European journal of radiology 2024-06, Vol.175, p.111436-111436, Article 111436
• Main Authors: Quentin, M., Boschheidgen, M., Radtke, J.P., Spohn, F., Ullrich, T., Drewes, L., Valentin, B., Lakes, J., Al-Monajjed, Arsov, C., Esposito, I., Albers, P., Antoch, G., Schimmöller, L.
• Format: Article
• Language: English
• Subjects: Aged; Humans; Image guided biopsy; Image-Guided Biopsy - methods; Magnetic Resonance Imaging - methods; Magnetic Resonance Imaging, Interventional - methods; Male; Middle Aged; Multimodal Imaging - methods; Multiparametric Magnetic Resonance Imaging - methods; Pathology; Prostate cancer; Prostate MRI; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Reproducibility of Results; Retrospective Studies; Ultrasonography, Interventional
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2024.111436

•Systematic and targeted MRI/US fusion-guided biopsy can miss csPC.•MRI in-bore biopsy detected csPC in 47% after inconclusive MRI/US fusion-guided biopsy.•MRI in-bore biopsy can used as backup in case of discordant imaging and pathology. Patients with suspicion of clinically significant prostate cancer (csPC) on multiparametric prostate MRI (mpMRI) but negative or inconclusive MRI/US fusion-guided biopsy (FB) can be challenging in clinical practice. To assess the utility of MRI in-bore biopsy (IB) in patients with discordant imaging and histopathological findings after FB. Consecutive patients with Prostate Imaging Reporting and Data System (PI-RADS) category 4 or 5 on mpMRI at 3T after FB without histologically confirmed csPC who underwent IB between 01/2014 and 05/2022, were retrospectively included. The primary objective was to assess the detection rate of csPC. Secondary objectives were to analyze clinical parameters, MRI parameters, and lesion localization. In the final cohort of 51 patients, the IB resulted in an overall detection rate of 71% for PC and 47% for csPC. Furthermore, in 55% of cases with initial low-grade PC, the Gleason score was upgraded after IB. CsPC was often detected apical and/or anterior. The detection rate for PC was 58% in PI-RADS category 4 and 94% in PI-RADS category 5 (csPC 39% and 61%, respectively). Patients with csPC had statistically significant smaller prostate volumes, a higher PI-RADS category, a higher prostate-specific antigen density (PSAD), and were older. For a relevant proportion of patients with PI-RADS category 4 or 5 and negative or inconclusive findings on previous FB, but with persistent suspicion of csPC, a subsequent IB verified the presence of csPC. Therefore, IB can be a backup in cases of uncertainty.