ABSTRACT BACKGROUND: The objective of this study was to analyze the potential of prostate magnetic resonance imaging (MRI) and MRI/transrectal ultrasound-fusion biopsies to detect and to

characterize significant prostate cancer (sPC) in the anterior fibromuscular stroma (AFMS) and in the transition zone (TZ) of the prostate and to assess the accuracy of multiparametric MRI

(mpMRI) and biparametric MRI (bpMRI) (T2w and diffusion-weighted imaging (DWI)). METHODS: Seven hundred and fifty-five consecutive patients underwent prebiopsy 3 T mpMRI and transperineal

biopsy between October 2012 and September 2014. MRI images were analyzed using PIRADS (Prostate Imaging-Reporting and Data System). All patients had systematic biopsies (SBs, median _n_=24)

RESULTS: One hundred and ninety-one patients harbored 194 lesions in AFMS and TZ on mpMRI. Patient-based analysis detected no difference in the detection of all PC for SBs vs TBs in the

overall cohort, but in the repeat-biopsy population TBs performed significantly better compared with SBs (_P_=0.004 for GS⩾3+4 and _P_=0.022 for GS⩾4+3, respectively). Nine GS⩾4+3 sPCs were

overlooked by SBs, whereas TBs missed two sPC in men undergoing primary biopsy. The combination of SBs and TBs provided optimal local staging. Non-inferiority analysis showed no relevant

difference of bpMRI to mpMRI in sPC detection. CONCLUSIONS: MRI-targeted biopsies detected significantly more anteriorly located sPC compared with SBs in the repeat-biopsy setting. The more

cost-efficient bpMRI was statistically not inferior to mpMRI in sPC detection in TZ/AFMS. Access through your institution Buy or subscribe This is a preview of subscription content, access

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TARGETED PLUS SYSTEMATIC MRI-ULTRASOUND FUSION PROSTATE BIOPSY, AND RADICAL PROSTATECTOMY PATHOLOGY Article Open access 28 April 2022 DIAGNOSTIC PERFORMANCE OF PI-RADS VERSION 2.1 COMPARED

TO VERSION 2.0 FOR DETECTION OF PERIPHERAL AND TRANSITION ZONE PROSTATE CANCER Article Open access 29 September 2020 A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE DIAGNOSTIC ACCURACY OF

BIPARAMETRIC PROSTATE MRI FOR PROSTATE CANCER IN MEN AT RISK Article 20 November 2020 REFERENCES * Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T _et al_. EAU

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67–74. Article  PubMed  Google Scholar  Download references AUTHOR INFORMATION Author notes * S Boxler Present address: 6Current address: Department of Urology, University Hospital Bern,

Bern, Switzerland., * T H Kuru Present address: 7Current address: Department of Urology, RWTH University Hospital, Aachen, Germany., AUTHORS AND AFFILIATIONS * Department of Urology,

University Hospital Heidelberg, Heidelberg, Germany J P Radtke, S Boxler, T H Kuru, I V Popeneciu, S Steinemann, C Huettenbrink, C Bergstraesser-Gasch, T Klein, C Kesch, M Hohenfellner &

 B A Hadaschik * Department of Radiology, German Cancer Research Center, Heidelberg, Germany J P Radtke, M Roethke & H-P Schlemmer * Department of Diagnostic and Interventional

Radiology, University Hospital Heidelberg, Heidelberg, Germany M B Wolf & C D Alt * Clinical Cancer Registry, National Center of Tumour Diseases, German Cancer Research Center,

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BAH is grateful for funding from the German Research Foundation, and the European Foundation for Urology. BAH has received research funding from MedCom and Uromed. None of these sources had

any input whatsoever into this article. The remaining authors declare no conflict of interest. ADDITIONAL INFORMATION Supplementary Information accompanies the paper on the Prostate Cancer

and Prostatic Diseases website SUPPLEMENTARY INFORMATION SUPPLEMENTARY TABLE 1 (DOC 90 KB) SUPPLEMENTARY TABLE 2 (DOC 35 KB) SUPPLEMENTARY TABLE 3 (DOC 86 KB) SUPPLEMENTARY TABLE 4 (PDF 54

KB) RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Radtke, J., Boxler, S., Kuru, T. _et al._ Improved detection of anterior fibromuscular stroma and

transition zone prostate cancer using biparametric and multiparametric MRI with MRI-targeted biopsy and MRI-US fusion guidance. _Prostate Cancer Prostatic Dis_ 18, 288–296 (2015).

https://doi.org/10.1038/pcan.2015.29 Download citation * Received: 10 March 2015 * Revised: 20 April 2015 * Accepted: 10 May 2015 * Published: 16 June 2015 * Issue Date: September 2015 *

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