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This is a retrospective review of all men between the ages of 18-89 who underwent transrectal ultrasound guided biopsy of the prostate either with HiRes or MRI/ultrasound fusion using the UroNav R platform at our center during the period of January 1, 2006 through October 23, 2020. This study is comprised of 1236 subjects. 442 underwent HiRes ultrasound guided biopsy; and 797 underwent MRI/ultrasound fusion biopsy. All patients concomitantly underwent a standard 12 core biopsy. Data was collected including PI-RADs or PRI-MUS score, grade, and location of prostate cancer (region of interest vs standard template). Chi-squared test was performed to determine if PI-RADs 3, 4 and 5 lesions are equal to PRI-MUS 3, 4, and 5.RESULTS: With MRI fusion biopsy cancer was found at PIRADs 3, 4, and 5 ROIs in 31%, 59% and 78% of patients respectively. With HiRes ultrasound biopsy cancer was found at PRI-MUS 3, 4, and 5 ROIs in 18%, 40% and 54% of patients respectively. MRI-fusion biopsy found 16% more cancers than standard biopsy alone. High resolution biopsy found 5% more cancers than standard biopsy alone. Chisquared analysis with alpha of 0.05 found that PI-RADS 3, 4, and 5 lesions and PRI-MUS 3, 4, and 5 lesions are not equal with regards to cancer yields.CONCLUSIONS: Our study found significant differences between PIRADs and PRI-MUS lesions and increased cancer detection with MRI-fusion biopsy vs HiRes biopsy. Multiple providers were involved in performing both types of biopsy and differences could be due to the subjective nature of HiRes biopsy. Both modalities increased cancer yield vs standard biopsy. More studies are needed to determine the role of MRI fusion vs HiRes biopsy; however, a combination of the two modalities holds significant potential.

not find any difference between starting with an mpMRI versus a 4Kscore, but prospective studies are needed for further validation.