Bi-parametric MRI/TRUS fusion targeted repeat biopsy after systematic 10-12 core TRUS-guided biopsy reveals more significant prostate cancer especially in anteriorly located tumors

Abstract

Background MRI and fusion guided biopsy have an increased role in the diagnosis of prostate cancer. Purpose To demonstrate the possible advantages with Bi-parametric MRI fusion-guided repeat biopsy over systematic 10–12-core biopsy for the diagnosis of prostate cancer. Material and Methods Four hundred and twenty-three consecutive men, with previous systematic 10–12-core TRUS-guided biopsy, and with suspicion of, or diagnosis of, low-risk prostate cancer underwent fusion-guided prostate biopsy between February 2015 and February 2017. The material was retrospectively assessed. In 220 cases no previous cancer was diagnosed, and in 203 cases confirmatory fusion guided biopsy was performed prior to active monitoring. MRI was classified according to PI-RADS. Systematic biopsy was compared to fusion guided biopsy for the detection of cancer, and PI-RADS was compared to the Gleason score. Results Fusion guided biopsy detected significantly more cancers than systematic ( p < .001). Gleason scores were higher in the fusion biopsy group ( p < .001). Anterior tumors were present in 54% of patients. Fusion biopsy from these lesions showed cancer in 53% with previously negative biopsy in systematic biopsies and 66% of them were upgraded from low risk to intermediate or high-risk cancers. Conclusion These results show superior detection rate and grading of bi-parametric MRI/TRUS fusion targeted repeat biopsy over systematic 10–12 core biopsies. Fusion guided biopsy detects more significant cancers despite using fewer cores. The risk group was changed for many patients initially selected for active surveillance due to upgrading of tumors. Bi-parametric MRI shows promising results in detecting anterior tumors in patients with suspected prostate cancer.

Outcomes of a Diagnostic Pathway for Prostate Cancer Based on Biparametric MRI and MRI-Targeted Biopsy Only in a Large Teaching Hospital

“…A diagnostic pathway using imaging as the main indication for biopsy using targeted cores only is a rational strategy; positive MRI is highly predictive of significant PCa and biopsy cores are more efficient due to targeting, especially when addressing tumors in the anterior part of the gland [26]. Contrarily, men with a negative MRI and other indications for biopsy have an a priori lower risk of significant PCa, and biopsy cores can only be applied systematically.…”

Analysis of risk factors for infection after transrectal ultrasound-guided prostate biopsy and analysis of the value of preoperative prophylactic antimicrobial use

“…In the context of China's aging population, there has been a noticeable increase in both the detection rate and incidence of prostate cancer in recent years [10,11]. TRUSPB has emerged as a valuable tool for prostate cancer diagnosis due to its straightforward maneuverability and clinically significant and beneficial outcomes [12][13][14]. Nevertheless, the widespread adoption of TRUSPB in clinical practice has drawn attention to its associated complications.…”