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Introducción: Las imágenes de resonancia magnética multiparamétrica (IRMmp) han optimizado el abordaje del cáncer de próstata y su diagnóstico. Objetivos: Comparar la detección de cáncer de próstata (CaP) entre pacientes que realizaron IRMmp previo a la re-biopsia y quienes no la realizaron. Material y métodos: Se seleccionaron retrospectivamente todos los pacientes con el antecedente de biopsias prostáticas previas negativas con persistencia de sospecha de CaP y posterior re-biopsia, en el Hospital Privado Centro Médico Universitario, Córdoba, Argentina. El periodo de inclusión de pacientes abarcó de enero 2012 a junio 2017. Se comparó la detección de CaP entre pacientes con y sin IRMmp, previo a la re-biopsia. Resultados: Se analizaron 216 biopsias de próstata. Se incluyeron 88 pacientes con antecedente de biopsia prostática previa negativa y posterior re-biopsia. Se conformaron 2 grupos: pacientes con IRMmp (44 pacientes) y pacientes que no realizaron IRMmp (44 pacientes). La edad promedio fue de 64 años (DE 7 años), el valor de antígeno prostático específico (APE) promedio fue de 10.4 ng/dl (DE 9,8 ng/dl), el volumen prostático promedio fue 60 cc. El promedio de biopsias previas fue de 1.37 episodios, con un promedio de punciones de 14.3, y un promedio de punciones en la biopsia final de 17.6. El 86.4% de los pacientes presentaba examen dígito rectal no sospechoso. Respecto al antecedente de biopsia previa, se encontró que en el 70% de los pacientes consistió en 12 punciones, y en un 12.8% fueron 18 punciones. En cuanto a la histología de la biopsia previa, se identificó 43% de los casos con Prostatitis Crónica y 42% con HPB. La presencia de Cáncer de Próstata en la biopsia final fue del 31% (27/88). No hubo diferencia en cuanto a edad, número de biopsias previas, tipo de biopsia final, histología previa, relación APE libre/total, entre el grupo con y sin IRMmp. No obstante, se encontró que el APE era significativamente mayor y el volumen prostático significativamente menor en el grupo con IRMmp. La presencia de Cáncer de próstata en el grupo con IRMmp previa fue de 43.2% vs 18.6% en el grupo sin IRMmp (p

The role of magnetic resonance imaging (MRI) prior to biopsy in the diagnosis of prostate cancer in biopsy-naïve patients has been strengthened by recent developments such as the PIRADS V2 criteria, which cover acquisition, interpretation, and reporting for clinical practice and data collection for research. Important questions on the role of prostate MRI remain: can MRI be used as a triage test before first biopsy series? Can it be used to avoid the use of systematic biopsies (SB) and instead use only targeted biopsies (TB) to MRI-suspicious lesions? Studies to evaluate image guided TB compared to SB have started to accumulate. Objectives of these studies should be to reduce the detection of clinically insignificant disease, to maximize the detection of clinically significant cancer (CSC), to better assess disease size, grade and location. Accurate diagnosis will allow the choice of the most appropriate treatments options, minimising side effects and reducing overtreatment. Study results on MRI-TB detection rates are promising however some limitations should be considered. The majority of published and ongoing studies have been performed at expert centres, in order to demonstrate the optimal performance of MRI. Then, the validation of this strategy in less specialised institutions will be necessary before incorporating recommendations in international guidelines. It necessitates training for radiologists and urologists to perform and read MRI and MRI-targeted biopsy through education programs and standardization tools. All these advances will be consolidated with expected genetic screening tools to improve the detection of aggressive cancer., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Purpose: We evaluated the prostate cancer detection with transperineal template-guided mapping biopsy in patients with elevated prostate-specific antigen and negative magnetic resonance imaging (MRI)-guided biopsy., Materials and Methods: Totally 75 patients underwent transperineal template-guided mapping biopsy for prior negative MRI-guided (cognitive registration) biopsy during April 2013 to August 2014. Primary objective was to report clinically significant cancer detection in this cohort of patients. Significant cancer was defined using varying thresholds of MCL or Gleason grade 3+4 or greater or both. Cancers with more than 80% of positive core length anterior to the level of urethra were termed anterior zone cancer. Secondary objective was to evaluate the potential clinical and radiological predictors for significant cancer detection., Results: The mean age was 61.6 ± 6.5 years and median prostate-specific antigen was 10.4 ng/dl (7.9-18) with a mean MRI target size of 7.2mm (4-11). Transperineal template-guided mapping biopsy identified cancer in 36% (27/75) patients and 66.6% (18/27) of them were anterior zone cancers. The rates of detection of clinically significant and insignificant cancer according to the several definitions used range from 22.7% to 30.7% and 5.3% to 13.3%, respectively. Multivariate analysis did not identify any predictors for finding clinically significant and anterior cancers in this group of patients., Conclusion: Transperineal template-guided mapping biopsy appears to be an excellent biopsy protocol for downstream management following negative MRI-guided biopsy. Most of the cancers detected were predominantly anterior tumors., (Copyright © 2015 Elsevier Inc. All rights reserved.)