ORIGINAL ARTICLE 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. Schilling Received: 6 January 2011 / Accepted: 28 March 2011 / Published online: 22 April 2011 Ó Springer-Verlag 2011 Abstract Purpose 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. Methods Patients with at least one negative trans-rectal- ultrasound-guided biopsy (TRUS-GB), persistently ele- vated 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. Results 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 sur- veillance. In total, 80.8% of the patients revealed a clini- cally 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. Conclusions MR-GB shows a high detection rate of clinically significant PCa in patients with previous negative TRUS-GB and persisting suspicion for PCa. Keywords Detection rate Á MRI-guided biopsy Á Prostate cancer Á PSA Á Significant carcinoma Á TRUS Introduction To date, systematic trans-rectal ultrasound-guided biopsy (TRUS-GP) of the prostate represents the gold standard for diagnosis of prostate cancer [12]. Approximately 24.1% of men in a screening population undergoing TRUS-guided biopsy (TRUS-GB) will be diagnosed with prostate cancer (PCa) [21]. Still the rate of false negative results may be as high as 35% depending on the biopsy technique used [17]. Patients with persisting suspicion of PCa after negative prostate biopsy pose a significant problem on both the patient and the treating urologist. Conventional gray scale TRUS has a limited sensitivity and specificity for the detection of malignant intraprostatic lesions [18], and the low detection rates after secondary or A. G. Anastasiadis Á P. Wagner Á S. Kruck Á A. Stenzl Á D. Schilling Department of Urology, Comprehensive Cancer Center (CCC) Tu ¨bingen, Eberhard-Karls-Universita ¨t, Tu ¨bingen, Germany M. Roethke Á M. Lichy Á M. Werner Á C. D. Claussen Department of Radiology, Comprehensive Cancer Center (CCC) Tu ¨bingen, Eberhard-Karls-Universita ¨t, Tu ¨bingen, Germany M. Roethke Á H. P. Schlemmer Department of Radiology, German Cancer Research Center, Heidelberg, Germany D. Schilling (&) Department of Urology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany e-mail: David.Schilling@med.uni-tuebingen.de 123 World J Urol (2012) 30:213–218 DOI 10.1007/s00345-011-0675-2