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 tumours

Abstract

<jats:title>Abstract</jats:title> <jats:p>Background To demonstrate possible advantages with Bi-parametric MRI fusion-guided repeat biopsy over systematic 10-12-core biopsy for diagnosis of prostate cancer. Methods All patients who underwent fusion guided biopsy between February 2015 to February 2017 were included. Four hundred twenty-three consecutive men, with previous systematic10-12-core TRUS-guided biopsy, with suspicion of or low-risk prostate cancer underwent fusion-guided prostate biopsy. 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 done and classified according to PI-RADS. Region of Interest (ROI) was marked. Systematic biopsy was compared to fusion guided biopsy for detection of cancer, as well as PI-RADS was compared to Gleason score. Results Fusion guided biopsy detected significantly more cancers than systematic (p &lt; 0.001). Gleason scores were higher in the fusion biopsy group (p &lt; 0,001). PI-RADS score correlated with the presence of cancer in fusion biopsies. PI-RADS 2 yielded 19% cancer and PI-RADS 3 56%, PI-RADS 4–5 were cancerous in 83%. Only 3 out of 53 biopsies from PI-RADS 2 lesions showed high grade cancer (Gleason score 4 + 3 and higher) compared to 10/133 (7,5%) from PI-RADS 3 lesions and 54/239 (23%) from PI-RADS 4–5. 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. There is significant impact on known cases of low-risk PCa with change of risk group for many patients initially selected for active surveillance.</jats:p>