Transrectal Ultrasound-Guided Prostate Biopsy for Cancer Detection: Performance of 2D-, 3D- and 3D-MRI Fusion Targeted Techniques

Abstract

Introduction: The study aimed to evaluate 3 different modalities of transrectal ultrasound (TRUS)-guided prostate biopsies (PBs; 2D-, 3D- and targeted 3D-TRUS with fusion to MRI - T3D). Primary end point was the detection rate of prostate cancer (PC). Secondary end point was the detection rate of insignificant PC according to the Epstein criteria. Patients and Methods: Inclusion of 284 subsequent patients who underwent 2D-, 3D- or T3D PB from 2011 to 2015. All patients having PB for initial PC detection with a serum prostate-specific antigen value ≤20 ng/ml were included. Patients with T4 and/or clinical and/or radiological metastatic disease, so as these under active surveillance were excluded. Results: Patients with T3D PB had a significantly higher detection rate of PC (58 vs. 19% for 2D and 38% for 3D biopsies; p = 0.001), with no difference in Gleason score distribution (p = 0.644), as well as detection rate of low-risk cancers (p = 0.914). Main predictive factor for positive biopsies was the technique used, with respectively a 3- and 8-fold higher detection rate in the 3D- and T3D group. For T3D-PB, there was a significant correlation between radiological cancer suspicion (Prostate Imaging Reporting and Data System Score) and cancer detection rate (p = 0.02). Conclusions: T3D PB should be preferred over 2D PB and 3D PB in patients with suspected PC as it improves the cancer detection rate.

Significance of MRI/Transrectal Ultrasound Fusion Three-Dimensional Model-Guided, Targeted Biopsy Based on Transrectal Ultrasound-Guided Systematic Biopsy in Prostate Cancer Detection: A Systematic Review and Meta-Analysis

“…As a result, most studies had to test the sensitivity and specificity relative to standard TRUS-guided 12-core Sb. In addition, most studies were before-after self-controlled, except that few studies were one-to-one matched [29] or grouping controlled [24,30]. Only the before-after, selfcontrolled study was included for analysis.…”

“…But their enrolled studies mostly performed targeted biopsy in MRI-TRUS 2D fusion model, which has a significantly different diagnostic capacity with 3D fusion [24]. Besides that meta-analysis had not assessed benefits of 3D-Tb combined with Sb.…”

Prostate Cancer Imaging and Biomarkers Guiding Safe Selection of Active Surveillance

“…In recent years, mpMRI has emerged as a reliable tool for monitoring patients on AS ( 13 , 16 ). The implementation of novel MRI analytic techniques such as diffusion-weighted imaging (DWI) and volumetric estimation algorithms have allowed for improved tumor characterization ( 17 – 19 ).…”

Pathology results, complications of prostate biopsies and correlation with radical prostatectomy: analysis of 1509 patients

“…Klein at al. (17) showed the superiority of 3 dimensional prostate biopsy comparing with 2 dimensional one. The necessity of repeat biopsy and the indications are still controversial.…”