Transrectal ultrasound-guided prostate biopsy versus combined magnetic resonance imaging-ultrasound fusion and systematic biopsy for prostate cancer detection in routine clinical practice

Abstract

Purpose: The goal of this study was to retrospectively compare systematic ultrasound-guided prostate biopsy (US-PB) and multiparametric magnetic resonance imaging-ultrasound fusion prostate biopsy (MRI-PB) in men undergoing primary or repeated biopsies. Methods: A population of 2,200 patients with a prostate-specific antigen (PSA) level >4.0 ng/ dL and/or an abnormal rectal examination was divided into two groups. All patients underwent US-PB (n=1,021) or MRI-PB (n=1,179) between April 2015 and April 2019. Population demographics, including age, PSA level, digital rectal examination results, prostate volume, number of previous negative biopsies, Prostate Imaging Reporting and Data System (PI-RADS) version 2 (V2) score, and biopsy results, were acquired and compared with respect to these variables. Univariate regression analysis of the risk factors for a higher Gleason score (GS) was performed. Results: The cancer detection rate (CDR) was 23.8% (243 of 1,021) in the US-PB group and 31.3% (399 of 1,179) in the MRI-PB group. Of those, 225 patients (22.0%) in the US-PB group and 374 patients (31.7%) in the MRI-PB group had clinically significant prostate cancer (csPCa). The patients with csPCa in the MRI-PB group included 10 (40%), 50 (62.5%), 184 (94.8%), and 32 (94.1%) patients with PI-RADS V2 scores of 2, 3, 4, and 5, respectively. Of the patients with csPCa, 155 (91.7%) in the US-PB group were diagnosed on the basis of the primary biopsy, compared to 308 (94.4%) in the MRI-PB group. We found the PI-RADS V2 score to be the best predictor of a higher GS. Conclusion: MRI-PB showed a high CDR for csPCa. MRI-PB could be a reasonable approach in patients with high PI-RADS V2 scores at primary biopsy.

Comparison of Accuracies between Real-Time Nonrigid and Rigid Registration in the MRI–US Fusion Biopsy of the Prostate

“…The introduction and popularization of multiparametric prostate MRI is changing the biopsy paradigm, as US-guided biopsy often fails to detect aggressive PCa [11,12]. Previous studies showed that the probability of detecting clinically significant PCa increases with higher scores when prostate MRI is analyzed using the Likert scale or PI-RADS categorization [13,14]. Therefore, direct MRI-guided biopsy or cognitive or software-assisted MRI-US fusion biopsy can be more helpful than the conventional USguided biopsy in determining prostatectomy [15,16].…”

Value of synthetic MRI quantitative parameters in preprocedural evaluation for TRUS/MRI fusion‐guided biopsy of the prostate

“…TRUS/MRI fusionguided biopsy also has a high clinical application value. [4][5][6] However, this technique has limitations, including the time-consuming protocol, high equipment requirements, and long learning cycle for biopsy physicians, which limit its use in routine clinical practice. Therefore, the selection of suitable proatate lesions for TRUS/MRI fusionguided biopsy is worthy of our attention.…”

“…Previous studies have shown that the higher the prostate lesion PI-RADS scores in patients, the greater the value of TRUS/MRI fusion-guided biopsy. 5,7 However, the use of PI-RADS for lesion scoring is mainly based on qualitative images of different Mp-MRI sequences and there is a lack of objective quantitative parameters. Hence, the results tend to be affected by the experience of the interpreting radiologist.…”

“…System biopsy (SB) combined with targeted biopsy (TB) is currently the most widely used prostate biopsy protocol in clinical practice, among which, transrectal ultrasound/magnetic resonance imaging (TRUS/MRI) fusion‐guided biopsy can be used for precise localization of lesions due to the high resolution of multi‐parameter MRI (MP‐MRI) toward soft tissues, as well as the ability to retain the portability and real‐time strength of ultrasound. TRUS/MRI fusion‐guided biopsy also has a high clinical application value 4–6 . However, this technique has limitations, including the time‐consuming protocol, high equipment requirements, and long learning cycle for biopsy physicians, which limit its use in routine clinical practice.…”

“…Therefore, the selection of suitable proatate lesions for TRUS/MRI fusion‐guided biopsy is worthy of our attention. Previous studies have shown that the higher the prostate lesion PI‐RADS scores in patients, the greater the value of TRUS/MRI fusion‐guided biopsy 5,7 . However, the use of PI‐RADS for lesion scoring is mainly based on qualitative images of different Mp‐MRI sequences and there is a lack of objective quantitative parameters.…”