Evaluation of MRI/Ultrasound Fusion-Guided Prostate Biopsy Using Transrectal and Transperineal Approaches

Abstract

Purpose To evaluate transrectal (TR) and transperineal (TP) approaches for MRI/ultrasound (MRI/US) fusion-guided biopsy to detect prostate cancer (PCa). Materials and Methods 154 men underwent multiparametric MRI and MRI/US fusion-guided biopsy between July 2012 and October 2016. 79/154 patients were biopsied with a TR approach and 75/154 with a TP approach. MRI was retrospectively analyzed according to PI-RADS version 2. PI-RADS scores were compared with histopathological results. Descriptive statistics, accuracy, and negative and positive predictive values were calculated. Histopathological results of first, second, and third MRI targeted biopsy cores were compared to evaluate the impact of one verus multiple targeted cores. Results Detection rates of PCa were 39% for TR biopsy and 75% for TP biopsy. Sensitivity/specificity for tumor detection with PI-RADS ≥ 4 were 81/69% for TR biopsy and 86/84% for TP biopsy. In 31% for TR biopsy and 19% for TP biopsy, PCa was found in the second or third MRI targeted biopsy core only. Conclusion MRI/US fusion-guided biopsy may be conducted with the TR as well as the TP approach with high accuracy, giving more flexibility for diagnosis and the option for focal treatment of PCa.

The Role of MRI-TRUS Fusion Biopsy in the Diagnosis of Clinical Significant Prostate Cancer (CsPca)

“…On the other hand, pain management is more challenging with the TP approach [26]. The average VAS score, used to measure the symptom severity and pain control, is higher than that related to the TR biopsy.…”

“…Both the TP and TR biopsies are very effective in diagnosing PCa and provide a superimposable detection rate. However, the TP approach allows a better sampling of the lesions located in the anterior part of the gland, therefore resulting in a greater percentage of PCa of the anterior zone compared with the TR approach (86.7 vs. 46.7%) [26,27].…”

“…Even if there is no significant difference between the TP and TR biopsies in terms of the overall complication rate, rectal bleeding and infection-related complications are more frequently observed when adopting the TR approach [25,26,28,29]. As the access to the prostate is via the rectal mucosa, the TR biopsy increases the likelihood of introducing rectal flora into the urinary tract and the blood circulation.…”

Elastography in prostate gland imaging and prostate cancer detection

“…MRI and ultrasound image fusion using a computer-assisted 3-dimensional transrectal ultrasound biopsy system enable an accuracy with less than 3 mm error for targeting suspected lesions. Convinced diagnosis of focal disease allows for the effective focal treatment [74][75][76].…”

Histotripsy: The Next Generation of High‐Intensity Focused Ultrasound for Focal Prostate Cancer Therapy

“…These trends have exposed the limitations in the conventional treatment of prostate carcinoma, including a considerable risk of recurrence and long‐term genitourinary morbidity, which have a substantial detrimental impact on the quality of life . The development of multiparametric magnetic resonance (MR) imaging and MR‐ultrasound (US) fusion‐guided biopsies has substantially improved the patient selection process.…”