MRI-Guided Biopsy May Increase Accuracy of PCa Diagnosis

Eur Urol. 2006;50:738-749

MRI-guided biopsy of the prostate may improve the diagnostic accuracy in men with elevated or rising PSA levels following previous negative transrectal ultrasound (TRUS)-guided biopsies, German researchers report.

Aristotelis G. Anastasiadis, MD, and his colleagues at the University of Tübingen studied 27 men with a PSA level greater than 4 ng/mL and/or suspicious finding on digital rectal exam, suspicious MRI findings, and at least one prior negative prostate biopsy. The men (median age of 66 years) had a median PSA level of 10.2 ng/mL. The investigators performed MRI-guided biopsies with a closed unit. The patients had a median prostate volume of 37.4 cm³ (mean, 48.4 cm³), and the mean number of cores obtained per patient was 5.22. Dr. Anastasiadis' group detected prostate cancer in 15 men (55.5%), a rate that the researchers called “promising.”

“According to our knowledge,” the authors wrote, “this is the largest cohort of consecutive men to be examined by MRI-guided transrectal biopsy of the prostate in this setting.”

The investigators cautioned that MRI-guided biopsy has limitations. For example, chronic prostatitis has similar morphologic patterns to cancerous lesions. In addition, the proper placement of the needle guide is time consuming because it has to be identified first on a localizer image. “Then, imaging in two planes perpendicular to each other must be planned and performed.” Furthermore, a good interdisciplinary cooperation between the urologist and  uroradiologist is important for optimal diagnostic performance.