Clinical Scorecard: Integration of T2 and diffusion-weighted MRI with template prostate biopsies in men with suspected prostate cancer and prior negative transrectal ultrasound-guided biopsies

At a Glance

Key Highlights

• Transperineal template biopsies (TPB) improve sampling of anterolateral prostate regions and may reduce infection risk compared to transrectal biopsies.
• T2-weighted MRI combined with diffusion-weighted imaging (DWI) provides anatomical and functional information aiding lesion localization with diagnostic accuracy ranging from 50 to 90%.
• Patient-specific 3D printed prostate molds based on mpMRI enable precise histopathological correlation with imaging and biopsy findings.

Guideline-Based Recommendations

Diagnosis

• Use mpMRI including T2-weighted and diffusion-weighted sequences prior to repeat biopsy in men with previous negative TRUS biopsies and rising PSA.
• Divide prostate into 27 regions of interest for lesion localization according to European consensus guidelines.
• Consider transperineal template biopsies for improved sampling, especially in men with negative MRI but persistent clinical suspicion.

Management

• Offer TPB as a second-line diagnostic procedure after negative TRUS biopsy and rising PSA.
• Incorporate mpMRI findings to guide biopsy targeting and improve detection of clinically significant prostate cancer.

Monitoring & Follow-up

• Perform MRI 6–7 weeks post-TRUS biopsy to minimize hemorrhage artifact.
• Use experienced uro-radiologists to assess mpMRI blinded to histopathology for unbiased lesion detection.

Risks

• Transperineal biopsy may reduce infection risk compared to transrectal approach.
• Post-biopsy hemorrhage can affect MRI interpretation if imaging is done too soon after biopsy.

Patient & Prescribing Data

Men with suspected prostate cancer, prior negative TRUS biopsies, and rising PSA undergoing TPB and mpMRI

TPB combined with mpMRI improves detection of prostate cancer lesions missed by TRUS biopsy; 3D printed molds facilitate accurate histopathological correlation.

Clinical Best Practices

• Schedule mpMRI at least 6–7 weeks after TRUS biopsy to reduce imaging artifacts.
• Use multiparametric MRI protocols including T2WI, DWI with multiple b-values, and dynamic contrast-enhanced sequences following European Society of Uro-radiology guidelines.
• Employ patient-specific 3D printed molds for precise orientation of prostatectomy specimens to MRI findings to enhance diagnostic accuracy.
• Adopt transperineal template biopsy technique for repeat biopsy in men with prior negative TRUS biopsies and rising PSA.

References

• European Society of Uro-radiology Guidelines 2012
• Urological Society of Australia and New Zealand Audit