<p><strong>In patients undergoing repeat biopsy with no prior prostate MRI, clinicians should obtain a prostate MRI prior to biopsy. (<em>Strong Recommendation; Evidence Level: Grade C</em>)</strong></p>
Discussion
Discussion
<p>Repeat biopsy is generally performed when there remains ongoing concern for GG2+ prostate cancer. One role for an MRI is to evaluate for suspicious lesions for targeted biopsy that may have been missed on a prior biopsy. In patients with a prior negative systematic biopsy, MRI will show a suspicious target (variably defined) in 36% to 90% of patients and a biopsy directed to the target will be positive in 37% to 66% of patients,<sup>283-287</sup> and positive for GG2+ cancer in 21% to 60% of patients.<sup>284, 286, 287</sup> In patients with a prior biopsy showing only GG1 disease, MRI will show a suspicious target (variably defined) in 33% to 51% of patients and a biopsy directed to the target will be positive for GG2+ disease in 49% to 90% of patients.<sup>156, 287-289</sup> Given the substantial rates of suspicious target identification and PPV for GG2+ disease in the repeat biopsy setting, an mpMRI is recommended if there was no prior imaging.</p>