Prospective comparison of transperineal magnetic resonance imaging/ultrasonography fusion biopsy and transrectal systematic biopsy in biopsy‐naïve patients

Abstract

ObjectivesTo evaluate the value of multiparametric magnetic resonance imaging (mpMRI) in the detection of significant prostate cancer (PCa) and to compare transperineal MRI/ ultrasonography fusion biopsy (fusPbx) with conventional transrectal systematic biopsy (sysPbx) in biopsy-na€ ıve patients. Patients and MethodsThis multicentre, prospective trial investigated biopsy-na€ ıve patients with suspicion of PCa undergoing transperineal fusPbx in combination with transrectal sysPbx (comPbx). The primary outcome was the detection of significant PCa, defined as Gleason pattern 4 or 5. We analysed the results after a study period of 2 years. ResultsThe study included 214 patients. The median (range) number of targeted and systematic cores was 6 (2-15) and 12 (6-18), respectively. The overall PCa detection rate of comPbx was 52%. FusPbx detected more PCa than sysPbx (47% vs 43%; P = 0.15). The detection rate of significant PCa was 38% for fusPbx and 35% for sysPbx (P = 0.296). The rate of missed significant PCa was 14% in fusPbx and 21% in sysPbx. ComPbx detected significantly more significant PCa than fusPbx and sysPbx alone (44% vs 38% vs 35%; P < 0.005). In patients presenting with Prostate Imaging Reporting and Data System (PI-RADS) 4 and 5 lesions there was a higher detection rate of significant PCa than in patients presenting with PI-RADS ≤3 lesions in comPbx (61% vs 14%; P < 0.005). ConclusionsFor biopsy-na€ ıve men with tumour-suspicious lesions in mpMRI, the combined approach outperformed both fusPbx and sysPbx in the detection of overall PCa and significant PCa. Thus, biopsy-na€ ıve patients may benefit from sysPbx in combination with mpMRI targeted fusPbx.

Primary magnetic resonance imaging/ultrasonography fusion‐guided biopsy of the prostate

“…Particularly, MRI/US fusion‐guided biopsy increased the detection of clinically relevant disease, whilst also decreasing the detection of low‐risk cancer with a reduced number of needed cores . As MRI/US fusion‐guided biopsy alone is currently not advised by most authors and in the current guidelines, an additional 10–12‐core SB is indicated . Consistently there is a reported superior performance of the combination of TB and SB in overall detection rate but also with an associated contamination with insignificant prostate cancer .…”

“…© 2018 The Authors BJU International © 2018 BJU International in the current guidelines, an additional 10-12-core SB is indicated [1,2,12,19]. Consistently there is a reported superior performance of the combination of TB and SB in overall detection rate but also with an associated contamination with insignificant prostate cancer [9,20,21].…”

Additive Value of Transrectal Systematic Ventral Biopsies in Combination with Magnet Resonance Imaging/Ultrasound Fusion-Guided Biopsy in Patients with 3 or More Negative Prostate Biopsies

“…There are studies reporting a limited additional value of SB in addition to TB [2,22], but other authors also conclude that TB should be combined with SB for improved detection of clinically significant PCa [26][27][28]. However, the integration of MRI/US fusion into the diagnostic pathway in patients with suspicion for PCa with previous negative prostate biopsy led to an increased diagnostic accuracy for the detection of clinically significant PCa (Gleason score ≥3 + 4 = 7a (ISUP 2).…”

Cancer core length from targeted biopsy: an index of prostate cancer volume and pathological stage

“…For repeat biopsy situations, MRI guidance has been endorsed by the AUA and the Society of Abdominal Radiology (SAR) . For first‐biopsy situations, available data are not yet clear . However, in the present study the predictive value of TB MCCL held true equally for men undergoing either first or repeat biopsy; thus, an additional reason for pre‐biopsy MRI – the potential for quantifying the index TV – is herein shown.…”