Multiparametric MRI of Prostate Cancer after Biopsy: Little Impact of Hemorrhage on Tumor Staging

  • Choi, Moon Hyung (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jung, Seung Eun (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Park, Yong Hyun (Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea) ;
  • Lee, Ji Youl (Catholic Cancer Research Institute, College of Medicine, The Catholic University of Korea) ;
  • Choi, Yeong-Jin (Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2017.05.16
  • Accepted : 2017.07.11
  • Published : 2017.09.30


Purpose: To evaluate differences in staging accuracy of prostate cancer according to the extent of hemorrhage on multiparametric MRI performed after biopsy. Materials and Methods: We enrolled 71 consecutive patients with biopsy-proven prostate cancer. Patients underwent MRI followed by a prostatectomy at our institution in 2014. Two radiologists reviewed the MRI to determine the tumor stage. Correlation between biopsy-MRI interval and extent of hemorrhage was evaluated. Regression analyses were used to determine factors associated with accuracy of tumor staging. Results: The mean interval between biopsy and MRI was $17.4{\pm}10.2days$ (range, 0-73 days). The interval between prostate biopsy and MRI and the extent of hemorrhage were not significantly correlated (P = 0.880). There was no significant difference in the accuracy rate of staging between the small and large hemorrhage groups. Conclusion: Biopsy-induced hemorrhage in the prostate gland is not sufficiently absorbed over time. The extent of hemorrhage and the short interval between biopsy and MRI may not impair tumor detection or staging on multiparametric MRI.


Supported by : Korean Society of Magnetic Resonance in Medicine (KSMRM)


  1. Bittencourt LK, de Hollanda ES, de Oliveira RV. Multiparametric MR imaging for detection and locoregional staging of prostate cancer. Top Magn Reson Imaging 2016;25:109-117
  2. Chamie K, Sonn GA, Finley DS, et al. The role of magnetic resonance imaging in delineating clinically significant prostate cancer. Urology 2014;83:369-375
  3. Delongchamps NB, Rouanne M, Flam T, et al. Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: combination of T2-weighted, dynamic contrast-enhanced and diffusionweighted imaging. BJU Int 2011;107:1411-1418
  4. Dickinson L, Ahmed HU, Allen C, et al. Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting. Eur Urol 2011;59:477-494
  5. Hoeks CM, Barentsz JO, Hambrock T, et al. Prostate cancer: multiparametric MR imaging for detection, localization, and staging. Radiology 2011;261:46-66
  6. Turkbey B, Brown AM, Sankineni S, Wood BJ, Pinto PA, Choyke PL. Multiparametric prostate magnetic resonance imaging in the evaluation of prostate cancer. CA Cancer J Clin 2016;66:326-336
  7. Turkbey B, Pinto PA, Mani H, et al. Prostate cancer: value of multiparametric MR imaging at 3 T for detection--histopathologic correlation. Radiology 2010;255:89-99
  8. Ueno Y, Tamada T, Bist V, et al. Multiparametric magnetic resonance imaging: Current role in prostate cancer management. Int J Urol 2016;23:550-557
  9. Kim TH, Jeong JY, Lee SW, et al. Diffusion-weighted magnetic resonance imaging for prediction of insignificant prostate cancer in potential candidates for active surveillance. Eur Radiol 2015;25:1786-1792
  10. Abd-Alazeez M, Ahmed HU, Arya M, et al. The accuracy of multiparametric MRI in men with negative biopsy and elevated PSA level--can it rule out clinically significant prostate cancer? Urol Oncol 2014;32:45 e17-22
  11. Futterer JJ, Briganti A, De Visschere P, et al. Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? A systematic review of the literature. Eur Urol 2015;68:1045-1053
  12. Park BK, Park JW, Park SY, et al. Prospective evaluation of 3-T MRI performed before initial transrectal ultrasoundguided prostate biopsy in patients with high prostatespecific antigen and no previous biopsy. AJR Am J Roentgenol 2011;197:W876-881
  13. Porpiglia F, Manfredi M, Mele F, et al. Diagnostic pathway with multiparametric magnetic resonance imaging versus standard pathway: results from a randomized prospective study in biopsy-naive patients with suspected prostate cancer. Eur Urol 2017;72:282-288
  14. White S, Hricak H, Forstner R, et al. Prostate cancer: effect of postbiopsy hemorrhage on interpretation of MR images. Radiology 1995;195:385-390
  15. Qayyum A, Coakley FV, Lu Y, et al. Organ-confined prostate cancer: effect of prior transrectal biopsy on endorectal MRI and MR spectroscopic imaging. AJR Am J Roentgenol 2004;183:1079-1083
  16. Ko YH, Song PH, Moon KH, Jung HC, Cheon J, Sung DJ. The optimal timing of post-prostate biopsy magnetic resonance imaging to guide nerve-sparing surgery. Asian J Androl 2014;16:280-284
  17. Weinreb JC, Barentsz JO, Choyke PL, et al. PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. Eur Urol 2016;69:16-40
  18. Tamada T, Sone T, Jo Y, et al. Prostate cancer: relationships between postbiopsy hemorrhage and tumor detectability at MR diagnosis. Radiology 2008;248:531-539
  19. Barrett T, Vargas HA, Akin O, Goldman DA, Hricak H. Value of the hemorrhage exclusion sign on T1-weighted prostate MR images for the detection of prostate cancer. Radiology 2012;263:751-757
  20. Iremashvili V, Pelaez L, Jorda M, et al. Prostate sampling by 12-core biopsy: comparison of the biopsy results with tumor location in prostatectomy specimens. Urology 2012;79:37-42
  21. Noguchi M, Stamey TA, McNeal JE, Yemoto CM. Relationship between systematic biopsies and histological features of 222 radical prostatectomy specimens: lack of prediction of tumor significance for men with nonpalpable prostate cancer. J Urol 2001;166:104-109; discussion 109-110
  22. Kim JW, Park HK, Kim HG, et al. Discordance between location of positive cores in biopsy and location of positive surgical margin following radical prostatectomy. Korean J Urol 2015;56:710-716
  23. Baco E, Rud E, Vlatkovic L, et al. Predictive value of magnetic resonance imaging determined tumor contact length for extracapsular extension of prostate cancer. J Urol 2015;193:466-472
  24. Barentsz JO, Richenberg J, Clements R, et al. ESUR prostate MR guidelines 2012. Eur Radiol 2012;22:746-757
  25. Ikonen S, Kivisaari L, Vehmas T, et al. Optimal timing of post-biopsy MR imaging of the prostate. Acta Radiol 2001;42:70-73
  26. Sharif-Afshar AR, Feng T, Koopman S, et al. Impact of post prostate biopsy hemorrhage on multiparametric magnetic resonance imaging. Can J Urol 2015;22:7698-7702