Comparison of systematic transrectal biopsy to transperineal magnetic resonance imaging/ultrasound‐fusion biopsy for the diagnosis of prostate cancer

Abstract

Objectives To compare targeted, transperineal magnetic resonance imaging (MRI)/ultrasound (US)‐fusion biopsy to systematic transrectal biopsy in patients with previous negative or first prostate biopsy and to evaluate the gain in diagnostic information with systematic biopsies in addition to targeted MRI/US‐fusion biopsies. Patients and Methods In all, 263 consecutive patients with suspicion of prostate cancer were investigated. All patients were evaluated by 3‐T multiparametric MRI (mpMRI) applying the European Society of Urogenital Radiology criteria. All patients underwent MRI/US‐fusion biopsy transperineally (mean nine cores) and additionally a systematic transrectal biopsy (mean 12 cores). Results In all, 195 patients underwent repeat biopsy and 68 patients underwent first biopsy. The median age was 66 years, median PSA level was 8.3 ng/mL and median prostate volume was 50 mL. Overall, the prostate cancer detection rate was 52% (137/263). MRI/US‐fusion biopsy detected significantly more cancer than systematic prostate biopsy (44% [116/263] vs 35% [91/263]; P = 0.002). In repeat biopsy, the detection rate was 44% (85/195) in targeted and 32% (62/195) in systematic biopsy (P = 0.002). In first biopsy, the detection rate was 46% (31/68) in targeted and 43% (29/68) in systematic biopsy (P = 0.527). In all, 80% (110/137) of biopsy confirmed prostate cancers were clinically significant. For the upgrading of Gleason score, 44% (32/72) more clinically significant prostate cancer was detected by using additional targeted biopsy than by systematic biopsy alone. Conversely, 12% (10/94) more clinically significant cancer was found by systematic biopsy additionally to targeted biopsy. Conclusions MRI/US‐fusion biopsy was associated with a higher detection rate of clinically significant prostate cancer while taking fewer cores, especially in patients with prior negative biopsy. Due to a high portion of additional tumours with Gleason score ≥7 detected in addition to targeted biopsy, systematic biopsy should still be performed additionally to targeted biopsy.

Transrectal ultrasound-guided biopsy for prostate cancer detection: Systematic and/or magnetic-resonance imaging-targeted

“…In a systematic review by Moore et al, cancer was detected in 30% of all targeted cores in a pooled analysis of 1252 targeted cores compared to 7% of all systematic TRUS-guided biopsy cores in a pooled analysis of 5441 systematic cores. 30 The 56.9% CDR performed by systematic biopsy in our study is relatively high compared to other recent series from the literature, such as 34% in Borkowetz et al 31 and 44.2% in the meta-analysis from Wu et al, 32 but comparable to others, such as 56.5% in Siddiqui et al 12 or 56.6% in Mozer et al; 14 however, the overall 39.2% CDR for csPCa achieved by systematic biopsy is comparable to most recently published studies, ranging from 26.2-36.8%. 11,12,14,32 Comparing biopsy-naive men with those after at least one previous negative biopsy, overall CDR and CDR for csPCa were higher in the biopsy-naive group vs. repeat biopsy (69.3 vs. 57.1% and 54 vs. 46.6%, respectively).…”

Direct comparison of multiparametric magnetic resonance imaging (MRI) results with final histopathology in patients with proven prostate cancer in MRI/ultrasonography‐fusion biopsy

“…In a previous study, we showed that fusion PBx was associated with a higher detection rate of clinically significant PCa, but we concluded that, because a high proportion of further tumours with GS ≥7 were detected by systematic PBx, systematic PBx should still be performed in addition to targeted PBx [15].…”

“…In a previous study, we reported a detection rate of 10% in PI-RADS ≤2 lesions for GS ≥7 tumours in patients undergoing combination PBx [15]. In the present study, the high detection rate in lesions classified as PI-RADS ≤2 compared with the RP specimen could be the result of positive selection, as all investigated patients in the present cohort had proven PCa; however, most of these PI-RADS score ≤2 lesions were associated with another lesion classified as PI-RADS ≥3 harbouring PCa so that the probability of finding evidence of PCa in lesions with PI-RADS ≤2 was higher in the present cohort.…”

Predictive Parameters Identifying Men Eligible for a Sole MRI/Ultrasound Fusion-Guided Targeted Biopsy without an Additional Systematic Biopsy

“…The PI-RADS scores were distributed as follows (for patients with multiple lesions, the highest PI-RADS is stated): 39 lesions (16%) PI-RADS 3; 126 lesions (50%) PI-RADS 4; 86 lesions (34%) PI-RADS 5. A median of 3 (IQR 3-4) biopsy cores were obtained by TB and the total number of biopsy cores added to 13 (median; IQR [13][14].…”

“…In order to create a standard of reporting for mpMRI, the 'Prostate Imaging Reporting and Data System' (PI-RADS) by the ' European Society of Urogenital Radiology' (ESUR) was established [11,12] . Studies stated that a PI-RADS-based CDR showed the likelihood of detecting cancer increases with higher PI-RADS scores, that is, 70-100% for PI-RADS 5 [13][14][15][16] . In patients meeting the PRIAS criteria for active surveillance, the PI-RADS score was a strong predictor for an upgrading or upstaging after radical prostatectomy [17] .…”