The role of MRI/TRUS fusion biopsy in the diagnosis of clinically significant prostate cancer

Abstract

Background: The aim of this work is to evaluate the detection rate of magnetic resonance imaging/transrectal ultrasound (MRI/TRUS) fusion-guided biopsy for clinically significant prostate cancers (Cs PCas), with particular interest in biopsy-naive patients and patients in active surveillance. MRI-targeted biopsy improves cancer detection rate (DR) in patients with prior negative biopsies; the current literature focuses on biopsy naive patients. We also evaluated the pathologic concordance between biopsies and surgical specimens. Methods: MRI/TRUS fusion-guided biopsies were performed between February 2016 and February 2019. Patients with previous negative biopsies, biopsy-naive or in active surveillance (AS) were included. Cs PCas were defined through Epstein’s criteria. Results: A total of 416 men were enrolled. The overall DRs and Cs PCa DRs were 49% and 34.3%, respectively. Cs PCas were 17.2%, 44.9% and 73.4%, respectively for PI-RADS 3, 4 or 5. Among biopsy-naive patients, 34.8% were found to have a Cs PCa, while a 43.6% tumour upgrading was achieved in men with a low risk of PCa. In patients who underwent radical prostatectomy (RP), the concordance between biopsy Gleason score (GS) (bGS) and pathological GS (pGS) was 90.8%. Conclusion: Our study highlights the role of MRI/TRUS fusion prostate biopsy in the detection of PCa in patients with previous negative biopsies focusing on Cs PCa diagnosis. The MRI/TRUS fusion biopsy is also emerging as a diagnostic tool in biopsy-naïve patients and deserves a fundamental role in AS protocols. A greater concordance between bGS and pGS can be achieved with targeted biopsies.

Single center results of magnetic resonance imaging ultrasound guided fusion prostate biopsy obtained patients

“…Ahmed et al reported that mpMRI-targeted biopsy have greater sensitivity than TRUS -guided biopsy (87% vs 60%) (15). In addition, it is known that in case of targeted and systematic biopsies are combined, detection rates of PCa cases increase (12). Consistent with the literature, our study shows that the combination of MRI-US FPBx and TRUS-Bx provides the highest rate of overall PCa and csPCa detection.…”

“…With advances in targeted biopsy technologies, MRI is increasingly playing a vital role in PCa diagnosis. Targeted biopsy detects more csPCa than systematic biopsy (12,13). Recently, a systematic review showed that cancer detection rates using the traditional method ranges from 26.3% to 56.6% and this ranges from 33% to 79.5% with targeted biopsy (14).…”

Artificial Intelligence for Clinical Diagnosis and Treatment of Prostate Cancer

“…The advancement in prostate cancer diagnosis has developed MRI-TRUS fusion-guided needle biopsies to efficiently predict prostate cancer [ 49 , 50 ]. The technique is time-consuming and laborious, so AI has been introduced to automate the process to reduce the burden on clinicians.…”

The Impact of Lifestyle on Prostate Cancer: A Road to the Discovery of New Biomarkers

“…MRI/TRUS can identify PCa patients with previous negative biopsies and clinically insignificant tumours, preventing overtreatment. Mainly limited by the economic resources that would be required, MRI/TRUS has been considered a significant diagnostic tool in PCa [ 35 ].…”