Single-Center Experience in Targeted Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging‑Transrectal Ultrasound Elastic Fusion Technique

Abstract

Introduction: Transrectal ultrasound (TRUS)-guided random biopsies are used to be the gold standard when diagnosing prostate cancer. A relatively new system with organ tracking that fuses real-time TRUS images with previously acquired multiparametric magnetic resonance imaging (mpMRI) images for prostate biopsy guidance is presented here. The primary goal of the study is to correlate (1) the mpMRI findings with the Gleason score grading of the prostate biopsies performed under mpMRI-TRUS elastic fusion and (2) the prostate-specific antigen (PSA) levels with the Gleason grading. Materials and Methods: Between January 2017 and August 2018, 58 patients had targeted prostate biopsy using mpMRI-TRUS elastic fusion technique (Urostation). These patients had previously the mpMRI of the prostate at our center using three-dimensional T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast enhanced imaging. Of all 58 patients, 32 patients were classified as having Prostate Imaging-Reporting And Data System (PI-RADS) 4/5, 21 patients as PI-RADS 3, and five as PI-RADS 2. Results: Twenty-seven patients had positive biopsies for prostate cancer. Positive results were found in 25 patients having PI-RADS 4/5 (25 out of 32). Of these patients, 20 had positive specimens from the dominant lesion, four from both the targeted lesion and nontargeted areas, and one from a nontargeted area. Positive results were found in two patients classified as PI-RADS 3 from targeted and nontargeted areas. These results show that 78% of the patients classified by mpMRI as PI-RADS 4/5 and 10% of the patients classified as PI-RADS 3 had positive biopsies for prostate cancer. The results also showed a correlation between the PI-RADS score on mpMRI, the Gleason score, and the PSA levels. Conclusion: mpMRI-TRUS fusion biopsy is a safe and accurate method for targeted prostate biopsies. Our preliminary results are comparable to the published international numbers and show a good correlation between the PI-RADS classification and histopathology, as well as correlation between PI-RADS, Gleason scores, and PSA levels of positive biopsies.