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Detecting Prostate Cancer—A Prospective Comparison of Systematic Prostate Biopsy With Targeted Biopsy Guided by Fused MRI and Transrectal Ultrasound by Dr. med. Marko Brock, Dr. med. Christian von Bodman, Dr. med. Jüri Palisaar, Dr. med. Wolfgang Becker, Dr. med. Philipp Martin-Seidel, and Prof. Dr. med. Joachim Noldus in issue 37/2015

The original article, Detecting Prostate Cancer, presented data from a prospective analysis of 168 patients with suspicion for prostate cancer (1). It compared MRI/TRUS fusion-guided targeted biopsy with systematic biopsy. In all patients, the methods were used simultaneously as long as a defined target lesion was identified in the previous MRI scan. Thus, the reader’s assumption that two patient groups were compared is incorrect.

Even though no peri-interventional complications were observed, bleeding or infection may have occurred after biopsy. According to Loeb et al., the morbidity of prostate biopsy is 4.2% (2). We have observed that morbidity also correlates with the number of biopsies sampled (2, 3). In our study, this complication rate is probably lower as we obtained less biopsy cores compared with conventional saturation biopsy and we had, in addition, a rectal swap and urine culture available before performing the biopsy.

After previous negative biopsy, a waiting period of at least eight weeks was observed before an MRI scan was performed. Neither scars nor abscesses were reported in any of the patients.

While improving the detection rate achieved with prostate biopsy, MRI alone, in our opinion, cannot determine the tumor stage in patients with prostate cancer. In our cohort, a significant portion of tumors were not detected with MRI, resulting in a false-negative rate of 9.6%. Microscopic evaluation of the abnormalities found is indispensable to establish infiltration of the capsule or detect minute lesions, often measuring only few millimeters in diameter.

DOI: 10.3238/arztebl.2016.0149b

Dr. med. Marko Brock

Klinik für Urologie und Neuro-Urologie, Universitätsklinikum der Ruhr-Universität Bochum, Germany

Conflict of interest statement

Dr. Brock has received consultancy fees as well as travel and accommodation expenses from Hitachi Medical Systems.

References

1. Brock M, von Bodman C, Palisaar J, Becker W, Martin-Seidel P, Noldus J: Detecting prostate cancer—a prospective comparison of systematic prostate biopsy with targeted biopsy guided by fused MRI and transrectal ultrasound. Dtsch Arztebl Int 2015; 112: 605–11

2. Loeb S, van den Heuvel S, Zhu X, Bangma CH, Schroder FH, Roobol MJ: Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol 2012; 61: 1110–4

3. Klein T, Palisaar RJ, Holz A, Brock M, Noldus J, Hinkel A: The impact of prostate biopsy and periprostatic nerve block on erectile and voiding function: a prospective study. J Urol 2010; 184: 1447–52