A recently published study by Japanese researchers in The Journal of Urology (2013;190:867-873) demonstrated that multiparametric magnetic resonance imaging (MRI) can improve detection of anterior prostate tumors missed by transrectal 12-core biopsy. 

In the study, 324 men underwent prebiopsy multiparametric MRI and then 3D 26-core prostate biopsy, a combination of transrectal 12-core and transperineal 14-core biopsy. The overall cancer detection rate on 3D 26-core prostate biopsy was 39%. 

Of these cancers, 28% were transrectal 12-core negative cancers, which the investigators defined as cancer detected by transperineal 14-core but not transrectal 12-core biopsy. Among men with and without an anterior lesion on MRI, 40% and 3.8%, respectively, had transrectal 12-core negative cancer. 

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Prebiopsy multiparametric MRI revealed an anterior lesion in 92% of cases of significant transrectal 12-core negative cancer.