Fusion‐targeted biopsy significantly improves prostate cancer detection in biopsy‐naïve men

Abstract

Objective The precise diagnosis of prostate cancer (PC) is crucial to avoid underdiagnosis, overdiagnosis, and overtreatment. We aimed to compare clinically significant PC (csPC) detection between MRI/ultrasound fusion‐targeted prostate (TBx) compared to systematic biopsy (SBx) in biopsy‐naïve Japanese men. Methods We included patients with suspect PC due to elevated PSA level or abnormal digital rectal examination, or both. csPC was defined as International Society Urological Pathology (ISUP) grade group ≥2 (csPC‐A) and ISUP grade group ≥3 (csPC‐B). Results This study included 143 patients. Overall PC detection was 66.4% for SBx and 67.8% for MRI‐TBx. MRI‐TBx presented a significantly higher rate of csPC detection (csPC‐A 67.1% vs. 58.7%, p = 0.04, and csPC‐B 49.6% vs. 39.9%, p < 0.001) and significantly lower detection of non‐csPC‐A (0.6% vs. 6.7%). Importantly, MRI‐TBx missed 4.9% (7/143) of csPC‐A and only 0.7% (1/143) of csPC‐B. On the other hand, SBx alone missed 13.3% (19/143) of csPC‐A and 4.2% (6/143) of csPC‐B. Conclusion MRI‐TBx significantly outperformed 12‐cores SBx for csPC detection and decreased non‐csPC detection in biopsy‐naive men. Performing MRI‐TBx without SBx would have missed some csPC, supporting that MRI‐TBx synergizes with SBx to increase csPC detection.

Editorial Comment to Fusion‐targeted biopsy significantly improves prostate cancer detection in biopsy‐naïve men

“…These biomarkers can obviate the need for unnecessary biopsies in patients with highest PI‐RADS category ≤3. In the present study, the combination of target and systematic biopsy has shown to improve csPC detection 3 . Although csPC detection based on MRI has been established and developed, the removal of systematic biopsy has still not been recommended for the detection of MRI‐invisible csPC.…”

“…Another study reported that, compared with systematic biopsy, csPC detection in the target biopsy was significantly higher 3 . Furthermore, csPC detection from a target biopsy for the region with Prostate Imaging Reporting and Data System (PI‐RADS) category ≤3 was found to be low 3 .…”

“…Another study reported that, compared with systematic biopsy, csPC detection in the target biopsy was significantly higher 3 . Furthermore, csPC detection from a target biopsy for the region with Prostate Imaging Reporting and Data System (PI‐RADS) category ≤3 was found to be low 3 . csPC detection from the region with PI‐RADS ≤3 is low, because the region includes adenoma of benign prostatic hyperplasia and chronic prostatitis.…”

Salvage robot‐assisted radical prostatectomy after carbon ion radiotherapy to the prostate

“…Local recurrence was diagnosed using transperineal systematic biopsy with MRI/ultrasound fusion-targeted prostate (TRINITY; Koelis, Grenoble, France). 10 Pathological diagnosis was performed by several institutional pathologists. The time to recurrence was defined as the duration from the date of initial diagnosis by biopsy to the date of local recurrence detected by biopsy.…”

Editorial Comment to “Fusion‐targeted biopsy significantly improves prostate cancer detection in biopsy‐naïve men”

“…Blas et al 1 . reported that magnetic resonance imaging (MRI)/ultrasound fusion‐targeted biopsy (MRI‐TBx) significantly outperformed 12‐core standard transrectal ultrasonography‐guided systematic biopsy (SBx) in terms of detecting clinically significant prostate cancer (csPC) and decreasing non‐csPC detection in biopsy‐naive men.…”