Multiparametric Magnetic Resonance Imaging-Ultrasound Fusion Transperineal Prostate Biopsy: Diagnostic Accuracy from a Single Center Retrospective Study

Abstract

The management of prostate biopsy in men with clinical suspicion of prostate cancer has changed in the last few years, especially with the introduction of imaging techniques, to overcome the low efficacy of risk stratification based on PSA levels. Here, we aimed to compare the diagnostic accuracy of multiparametric MRI with fusion ultrasound-guided prostate biopsy and standard biopsy, both performed through the transperineal route. To this end, we retrospectively analyzed 272 patients who underwent combined transperineal targeted and standard biopsy during the same session. The primary outcome was to compare the cancer detection rate between targeted and standard biopsy. The secondary outcome was to evaluate the added value of combined targeted and standard biopsy approach as compared to only targeted or standard biopsy. Results showed that a rate of 16.7% clinically significant tumors (International Society of Urological Pathology (ISUP) grade ≥ 2) would have been lost if only the standard biopsy had been used. The combined targeted and standard biopsy showed an added value of 10.3% and 9.9% in reducing the risk of prostate cancer missing after targeted or standard biopsy alone, respectively. The combined targeted and standard biopsy pathway is recommended to reduce the risk of missing clinically significant prostate cancer.

A Systematic Review of the Current Status of Magnetic Resonance–Ultrasound Images Fusion Software Platforms for Transperineal Prostate Biopsies

“…Of the 30 articles, 21 studies were conducted prospectively (none randomized) [ 21 , 22 , 24 , 27 , 28 , 29 , 30 , 32 , 33 , 34 , 35 , 38 , 39 , 40 , 41 , 42 , 43 , 48 , 49 , 50 ] and nine retrospectively [ 23 , 25 , 26 , 31 , 36 , 37 , 44 , 45 , 47 ].…”

“…Eight series were multicenter [ 21 , 24 , 25 , 26 , 34 , 35 , 40 , 49 ] while the remaining 22 were from a single center [ 22 , 23 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 36 , 37 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 50 ]. Overall, the characteristics and biopsy results of 11,313 patients were analyzed.…”

“…The study population included two articles [ 42 , 45 ] on patients with naïve biopsy, three articles [ 34 , 35 , 48 ] on patients with previous negative biopsy, twelve articles [ 22 , 23 , 24 , 26 , 28 , 30 , 32 , 33 , 36 , 41 , 43 , 44 ] on patients with naïve biopsy and previous negative biopsy, eleven studies [ 27 , 29 , 31 , 37 , 38 , 39 , 40 , 46 , 47 , 49 , 50 ] on patients with naïve biopsy and previous negative biopsy and patients in active surveillance (AS) and finally, two articles by Jacewicz et al [ 21 , 25 ] on patients with no prior biopsy, patients with prior negative biopsy, AS, focal therapy (FT) control, and SBRT recurrence. These data are presented in Table 3 .…”

“…All resonances performed prior to the biopsies were carried out via 1.5 or 3.0 Tesla resonators scans and interpreted using the PI-RADS score Version 1.0 in 1 article [ 34 ], version 2.0 in 26 studies [ 21 , 22 , 23 , 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 48 , 50 ], and version 2.1 in 1 article [ 45 ]. In two series [ 26 , 49 ], the reading of the resonance was carried out using the Likert scale.…”

Urological Cancer Panorama in the Second Year of the COVID-19 Pandemic

“…Four contributions analyze different aspects of the diagnostic process in prostate cancer. For example, Fulco et al [11] evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging-ultrasound fusion trans-perineal prostate biopsy. This single center retrospective study of 272 patients shows that a total of 16.7% of clinically significant tumors would have been undetected with standard biopsy methods.…”