Volume 69, Issue 1, Pages (January 2016)

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Volume 69, Issue 1, Pages 149-156 (January 2016) A Randomized Controlled Trial To Assess and Compare the Outcomes of Two-core Prostate Biopsy Guided by Fused Magnetic Resonance and Transrectal Ultrasound Images and Traditional 12-core Systematic Biopsy Eduard Baco, Erik Rud, Lars Magne Eri, Gunnar Moen, Ljiljana Vlatkovic, Aud Svindland, Heidi B. Eggesbø, Osamu Ukimura European Urology Volume 69, Issue 1, Pages 149-156 (January 2016) DOI: 10.1016/j.eururo.2015.03.041 Copyright © 2015 European Association of Urology Terms and Conditions

Fig. 1 Study flow diagram. European Urology 2016 69, 149-156DOI: (10.1016/j.eururo.2015.03.041) Copyright © 2015 European Association of Urology Terms and Conditions

Fig. 2 Results for a 59-yr-old man with prostate-specific antigen of 7.6 ng/ml, a normal digital rectal examination, and a prostate volume of 50ml. The patient had a positive family history of metastatic prostate cancer (his father). Prebiopsy magnetic resonance imaging, in terms of (A) a T2-weighed image, (B) a T2-weighted image with superimposed b2000, and (C) an apparent diffusion coefficient map with color overlay, was normal. (D,E) A 12-core random biopsy revealed Gleason 4+5 and 5+4 prostate cancer in the paramedial left prostate base and mid gland (demonstrated in three-dimensional registered biopsy needle trajectories; UroStation). Positive cores are registered as red bars; the cancer core length was 4 and 3mm (50% and 37% cancer core invasion). Green bars represent negative cores. The patient was treated with radical prostatectomy. (F) Histologic analysis of a step-sectioned prostate specimen confirmed pT3 Gleason 5+4 prostate cancer with neuroendocrine differentiation localized in the central and peripheral zone. The tumor dimensions were 27mm × 16mm × 16mm (3.5ml) and the tumor location corresponded to the three-dimensional location of positive cores. European Urology 2016 69, 149-156DOI: (10.1016/j.eururo.2015.03.041) Copyright © 2015 European Association of Urology Terms and Conditions

Fig. 3 Results for a 67-yr-old man with prostate-specific antigen of 7.2 ng/ml, a normal digital rectal examination, and a prostate volume of 75ml. Prebiopsy magnetic resonance imaging (MRI) suggested anterior prostate cancer visible on (A) axial T2-weighted images and (B) an apparent diffusion coefficient map with color overlay (arrows). MRI/transrectal ultrasound (TRUS)-targeted biopsy (red bars), as demonstrated by (C) axial and (D) sagittal MRI/TRUS fused images, revealed Gleason 3+4 prostate cancer. The cancer core length was 9 and 5mm (53% and 45% cancer core invasion). The patient was treated with radical prostatectomy. (E) A step-sectioned prostate specimen confirmed pT2 Gleason 3+4 prostate cancer. The tumor dimensions were 20mm × 17mm × 12mm (2.2ml) in the right anterior mid-gland region. (F) Positive biopsies (red bars) and the targeted region (yellow circle) shown in (C) and (D) corresponded to the three-dimensional tumor location in segment 10p. European Urology 2016 69, 149-156DOI: (10.1016/j.eururo.2015.03.041) Copyright © 2015 European Association of Urology Terms and Conditions