Where Do Transrectal Ultrasound- and Magnetic Resonance Imaging-guided Biopsies Miss Significant Prostate Cancer?

Area of Science:

• Urologic Oncology
• Diagnostic Imaging
• Interventional Radiology

Background:

• Repeat biopsies are common in men with prior negative transrectal ultrasound-guided biopsy (TRUS_bx).
• Identifying missed significant prostate cancer (sPCa) lesions is crucial for effective management.
• Multiparametric magnetic resonance imaging (mpMRI) aids in localizing suspicious prostate lesions.

Purpose of the Study:

• To determine the anatomical locations of sPCa lesions missed by both TRUS_bx and mpMRI-guided biopsy (mpMRI_bx) during repeat biopsies.
• To analyze the detection rates of sPCa lesions by different biopsy techniques.

Main Methods:

• 289 men with prior negative TRUS_bx underwent mpMRI.
• Suspicious lesions were scored using Prostate Imaging Reporting and Data System version 1.
• All patients had repeat TRUS_bx (reTRUS_bx) and targeted mpMRI_bx (image fusion); results were compared to identify missed sPCa locations.

Main Results:

• Prostate cancer was detected in 44% of patients, with 30% having sPCa (88/289).
• mpMRI_bx detected 90% of sPCa lesions, while reTRUS_bx detected 68%.
• Lesions missed by primary TRUS_bx were often anterior or apical (78%). Missed lesions at repeat biopsy were anterior for reTRUS_bx (84%) and posterolateral midprostatic for mpMRI_bx (60%).

Conclusions:

• Both TRUS_bx and mpMRI_bx can miss sPCa lesions in specific prostate segments.
• Repeat TRUS_bx most frequently missed anterior lesions, whereas mpMRI_bx missed posterolateral midprostatic lesions.
• Targeting these specific anatomical locations during repeat biopsies may enhance the detection of sPCa.