Using multiparametric magnetic resonance imaging and transrectal ultrasound fusion-guided biopsy (MRI-TRUS) with cognitive assistance can detect local recurrence of prostate cancer (PCa) after radical prostatectomy—even at low PSA levels, a new study finds.

Investigators led by Baris Turkbey, MD, of the National Cancer Institute in Baltimore, identified 10 men with rising PSA levels and no metastases following RP. All had suspicious lesions on initial imaging with multiparametric MRI. The lesions showed positive features on T2-weighted and dynamic contrast-enhanced images; 89% on apparent diffusion coefficient maps of diffusion-weight images. What best revealed the lesions were strong enhancement on dynamic contrast-enhanced images and focal hypointensity on T2-weighted images (at a magnetic field of 3 Tesla). The average lesion diameter was 1.12 cm.

MRI-TRUS fusion biopsy with cognitive assistance identified 62.5% of the target lesions as prostatic adenocarcinoma in 8 patients (80%), the researchers reported online ahead of print in Urologic Oncology. Among patients with PSA levels less than 2 ng/mL, the fusion biopsy technique found recurrent disease in 75%. The cognitive assistance component involved using the lesions as visual aids to match up the MR and TRUS images because the usual landmark, the prostate, was missing. Two cores per lesion were taken.

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“The prostatic fossa is notoriously difficult to biopsy, and these early results suggest that MRI-TRUS fusion guidance may aid in the localization of targets when compared with TRUS guidance alone,” the investigators wrote.

Early detection and diagnosis of recurrent local lesions using MRI-TRUS fusion biopsy may improve patient outcomes when followed by early salvage treatment. Larger studies are needed to confirm these results.  


  1. Muller, BG; Kaushal, A; Sankineni, S; et al. Urologic Oncology; doi: 10.1016/jurolonc.2015.05.021.