World Journal of Urology

, Volume 30, Issue 2, pp 213–218 | Cite as

MRI-guided prostate biopsy detects clinically significant cancer: analysis of a cohort of 100 patients after previous negative TRUS biopsy

  • M. Roethke
  • A. G. Anastasiadis
  • M. Lichy
  • M. Werner
  • P. Wagner
  • S. Kruck
  • Claus D. Claussen
  • A. Stenzl
  • H. P. Schlemmer
  • D. SchillingEmail author
Original Article



To investigate the positive biopsy rate of MRI-guided biopsy (MR-GB) in a routine clinical setting, identify factors predictive for positive biopsy findings and to report about the clinical significance of the diagnosed tumors.


Patients with at least one negative trans-rectal-ultrasound-guided biopsy (TRUS-GB), persistently elevated or rising serum prostate specific antigen (PSA) and at least one lesion suspicious for PCa on diagnostic 1.5 Tesla endorectal coil MRI (eMR) were included. Biopsies were carried out using a 1.5 Tesla MRI and an 18 G biopsy gun. Clinical information and biopsy results were collected; logistic regression analysis was carried out. Definite pathology reports of patients with diagnosis of PCa and subsequent radical prostatectomy (RP) were analyzed for criteria of clinical significance.


One hundred patients were included, mean number of previous biopsies was 2 (range 1–9), mean PSA at time of biopsy was 11.7 ng/ml (1.0–65.0), and mean prostate volume was 46.7 ccm (range 13–183).

In 52/100 (52.0%) patients, PCa was detected. Out of 52 patients, 27 patients with a positive biopsy underwent RP, 20 patients radiation therapy, and 5 patients active surveillance. In total, 80.8% of the patients revealed a clinically significant PCa.

In univariate regression analysis, only serum PSA levels were predictive for a positive biopsy result. Number of preceding negative biopsies was not associated with the likelihood of a positive biopsy result.


MR-GB shows a high detection rate of clinically significant PCa in patients with previous negative TRUS-GB and persisting suspicion for PCa.


Detection rate MRI-guided biopsy Prostate cancer PSA Significant carcinoma TRUS 



The authors thank Miriam Germann for critically proof reading and reviewing the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Ahmed HU, Kirkham A, Arya M et al (2009) Is it time to consider a role for MRI before prostate biopsy? Nat Rev Clin Oncol 6:197–206PubMedCrossRefGoogle Scholar
  2. 2.
    Amsellem-Ouazana D, Younes P, Conquy S et al (2005) Negative prostatic biopsies in patients with a high risk of prostate cancer. Is the combination of endorectal MRI and magnetic resonance spectroscopy imaging (MRSI) a useful tool? A preliminary study. Eur Urol 47:582–586PubMedCrossRefGoogle Scholar
  3. 3.
    Anastasiadis AG, Lichy MP, Nagele U et al (2006) MRI-guided biopsy of the prostate increases diagnostic performance in men with elevated or increasing PSA levels after previous negative TRUS biopsies. Eur Urol 50:738–748PubMedCrossRefGoogle Scholar
  4. 4.
    Beyersdorff D, Winkel A, Hamm B et al (2005) MR imaging-guided prostate biopsy with a closed MR unit at 1.5 T: initial results. Radiology 234:576–581PubMedCrossRefGoogle Scholar
  5. 5.
    Colleselli D, Schilling D, Lichy MP et al (2010) Topographical sensitivity and specificity of endorectal coil magnetic resonance imaging for prostate cancer detection. Urol Int 84:388–394PubMedCrossRefGoogle Scholar
  6. 6.
    Deliveliotis C, Varkarakis J, Albanis S et al (2002) Biopsies of the transitional zone of the prostate. Should it be done on a routine basis, when and why? Urol Int 68:113–117PubMedCrossRefGoogle Scholar
  7. 7.
    Djavan B, Milani S, Remzi M (2005) Prostate biopsy: who, how and when. An update. Can J Urol 12(Suppl 1):44–48PubMedGoogle Scholar
  8. 8.
    Engelhard K, Hollenbach HP, Kiefer B et al (2006) Prostate biopsy in the supine position in a standard 1.5-T scanner under real time MR-imaging control using a MR-compatible endorectal biopsy device. Eur Radiol 16:1237–1243PubMedCrossRefGoogle Scholar
  9. 9.
    Fradet V, Kurhanewicz J, Cowan JE et al (2010) Prostate cancer managed with active surveillance: role of anatomic MR imaging and MR spectroscopic imaging. Radiology 256:176–183PubMedCrossRefGoogle Scholar
  10. 10.
    Hambrock T, Futterer JJ, Huisman HJ et al (2008) Thirty-two-channel coil 3T magnetic resonance-guided biopsies of prostate tumor suspicious regions identified on multimodality 3T magnetic resonance imaging: technique and feasibility. Invest Radiol 43:686–694PubMedCrossRefGoogle Scholar
  11. 11.
    Hambrock T, Somford DM, Hoeks C et al (2010) Magnetic resonance imaging guided prostate biopsy in men with repeat negative biopsies and increased prostate specific antigen. J Urol 183:520–527PubMedCrossRefGoogle Scholar
  12. 12.
    Heidenreich A, Aus G, Bolla M et al (2008) EAU guidelines on prostate cancer. Eur Urol 53:68–80PubMedCrossRefGoogle Scholar
  13. 13.
    Labanaris AP, Zugor V, Smiszek R et al (2010) Guided e-MRI prostate biopsy can solve the discordance between Gleason score biopsy and radical prostatectomy pathology. Magn Reson Imaging 28:943–946PubMedCrossRefGoogle Scholar
  14. 14.
    Lichy MP, Pintaske J, Kottke R et al (2005) 3D proton MR spectroscopic imaging of prostate cancer using a standard spine coil at 1.5 T in clinical routine: a feasibility study. Eur Radiol 15:653–660PubMedCrossRefGoogle Scholar
  15. 15.
    Lujan M, Paez A, Santonja C et al (2004) Prostate cancer detection and tumor characteristics in men with multiple biopsy sessions. Prostate Cancer Prostatic Dis 7:238–242PubMedCrossRefGoogle Scholar
  16. 16.
    McNeal JE (1969) Origin and development of carcinoma in the prostate. Cancer 23:24–34PubMedCrossRefGoogle Scholar
  17. 17.
    Norberg M, Egevad L, Holmberg L et al (1997) The sextant protocol for ultrasound-guided core biopsies of the prostate underestimates the presence of cancer. Urology 50:562–566PubMedCrossRefGoogle Scholar
  18. 18.
    Pallwein L, Mitterberger M, Pelzer A et al (2008) Ultrasound of prostate cancer: recent advances. Eur Radiol 18:707–715PubMedCrossRefGoogle Scholar
  19. 19.
    Park BK, Lee HM, Kim CK et al (2008) Lesion localization in patients with a previous negative transrectal ultrasound biopsy and persistently elevated prostate specific antigen level using diffusion-weighted imaging at three Tesla before rebiopsy. Invest Radiol 43:789–793PubMedCrossRefGoogle Scholar
  20. 20.
    Roethke MC, Lichy MP, Jurgschat L, et al. (2010) Tumorsize dependent detection rate of endorectal MRI of prostate cancer—A histopathologic correlation with whole-mount sections in 70 patients with prostate cancer. Eur J RadiolGoogle Scholar
  21. 21.
    Schroder FH, Hugosson J, Roobol MJ et al (2009) Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 360:1320–1328PubMedCrossRefGoogle Scholar
  22. 22.
    Sciarra A, Panebianco V, Ciccariello M et al (2010) Value of magnetic resonance spectroscopy imaging and dynamic contrast-enhanced imaging for detecting prostate cancer foci in men with prior negative biopsy. Clin Cancer Res 16:1875–1883PubMedCrossRefGoogle Scholar
  23. 23.
    Umbehr M, Bachmann LM, Held U et al (2009) Combined magnetic resonance imaging and magnetic resonance spectroscopy imaging in the diagnosis of prostate cancer: a systematic review and meta-analysis. Eur Urol 55:575–590PubMedCrossRefGoogle Scholar
  24. 24.
    Uzzo RG, Wei JT, Waldbaum RS et al (1995) The influence of prostate size on cancer detection. Urology 46:831–836PubMedCrossRefGoogle Scholar
  25. 25.
    Yuen JS, Thng CH, Tan PH et al (2004) Endorectal magnetic resonance imaging and spectroscopy for the detection of tumor foci in men with prior negative transrectal ultrasound prostate biopsy. J Urol 171:1482–1486PubMedCrossRefGoogle Scholar
  26. 26.
    Zackrisson B, Aus G, Bergdahl S et al (2004) The risk of finding focal cancer (less than 3 mm) remains high on re-biopsy of patients with persistently increased prostate specific antigen but the clinical significance is questionable. J Urol 171:1500–1503PubMedCrossRefGoogle Scholar
  27. 27.
    Zakian KL, Sircar K, Hricak H et al (2005) Correlation of proton MR spectroscopic imaging with gleason score based on step-section pathologic analysis after radical prostatectomy. Radiology 234:804–814PubMedCrossRefGoogle Scholar
  28. 28.
    Zangos S, Eichler K, Engelmann K et al (2005) MR-guided transgluteal biopsies with an open low-field system in patients with clinically suspected prostate cancer: technique and preliminary results. Eur Radiol 15:174–182PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • M. Roethke
    • 2
    • 3
  • A. G. Anastasiadis
    • 1
  • M. Lichy
    • 2
  • M. Werner
    • 2
  • P. Wagner
    • 1
  • S. Kruck
    • 1
  • Claus D. Claussen
    • 2
  • A. Stenzl
    • 1
  • H. P. Schlemmer
    • 3
  • D. Schilling
    • 1
    • 4
    Email author
  1. 1.Department of UrologyComprehensive Cancer Center (CCC) Tübingen, Eberhard-Karls-UniversitätTübingenGermany
  2. 2.Department of RadiologyComprehensive Cancer Center (CCC) Tübingen, Eberhard-Karls-UniversitätTübingenGermany
  3. 3.Department of RadiologyGerman Cancer Research CenterHeidelbergGermany
  4. 4.Department of UrologyUniversity of TuebingenTuebingenGermany

Personalised recommendations