MRI-TRUS fusion guided prostate biopsy – initial experience and assessment of the role of contralateral lobe systematic biopsy

Abstract

Aims: To present our initial experience and results of MRI-TRUS fusion guided prostate biopsy and assess the role of contralateral lobe systematic biopsy.Material and method: A number of 119 patients with clinical or biochemical suspicion for prostate cancer (PCa) were included. All patients harbored at least one PIRADS score ≥ 3 lesion and underwent MRI-TRUS fusion guided biopsy, as well as a concurrent systematic biopsy. The biopsy was performed by the same operator, using a rigidregistration software system.Results: The mean age of the patients was 62.2 years. The mean pre-biopsy PSA was 9.15 ng/dl. The diagnosis rate of MRI-TRUS fusion guided biopsy was 47% for overall PCa and 29.4% for clinically significant (cs) PCa. A higher PIRADS score was significantly associated with the presence of overall and csPCa. MRI-TRUS fusion guided biopsy had a higher percentage of positive biopsy cores (51% vs 29%), higher likelihood of csPCa (OR 5.36, p=0.008) and upgrading (14.8%) in comparison with systematic biopsy but missed 6.7% csPCa. The contralateral lobe systematic biopsy could have been avoided without losing the PCa diagnosis all patients with PIRADS score 5, both in initial and repeat biopsy setting. Anterior and transitional lesions were more likely to be diagnosed only by targeted cores.Conclusion: MRI-TRUS guided prostate biopsy improves the detection of PCa, but systematic biopsy is still essential. In selected cases (PIRADS 5), contralateral lobe systematic biopsy can safely be avoided. Pre-biopsy mpMRI might reduce the number of biopsy sessions in patients with anterior and transitional lesions.

Diagnostic Performance of a Magnetic Resonance Imaging-directed Targeted plus Regional Biopsy Approach in Prostate Cancer Diagnosis: A Systematic Review and Meta-analysis

“…For biopsy-naïve men, the European Association of Urology (EAU) guidelines on prostate cancer (PCa) diagnosis currently recommend upfront magnetic resonance imaging (MRI) and then an MRI-directed targeted biopsy (TBx) plus systematic biopsy (SBx) approach in MRI-positive cases [1] . With this recommended biopsy approach, both the ipsilateral and contralateral lobes are still biopsied in a predominantly random systematic fashion, which is unique in the diagnostic process for solid-organ cancers [2] , [3] . Most men benefit diagnostically from increased (perilesional/regional) sampling of the index lesion, while complementary SBx can increase unnecessary biopsy cores, potential harms, and patient burdens, and identify indolent cancers in men with false-positive MRI scans [4] , [5] , [6] , [7] , [8] .…”

Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting—prospective single center experience after 300 cases in first biopsy setting

“…MRI interpretation was provided by 3 radiologists with more than 5 years experience. Our protocol for mpMRI acquisition performed was previously detailed (14). The radiologists were aware of the clinical information of the patients.…”

Analyzing the learning curves of a novice and an experienced urologist for transrectal magnetic resonance imaging-ultrasound fusion prostate biopsy

“…The majority of mpMRI were performed on 1.5T scanners with or without endorectal coil at radiologists' discretion. The protocol and acquisition parameters for our institution were previously described (13). The minimal requirements for including patients with external MRI were multiparametric scan including T2 weighted imaging, diffusion weighted imaging, dynamic contrast enhancement and at least 1.5T magnetic field strength, together with a written report from the radiologist locating the ROI.…”