The accuracy of prostate cancer diagnosis in biopsy-naive patients using combined magnetic resonance imaging and transrectal ultrasound fusion-targeted prostate biopsy

Abstract

Background: This study aimed to estimate whether multiparametric magnetic resonance imaging (mpMRI)-transrectal ultrasound (TRUS) fusion biopsy (FUS-TB) increases the detection rates of clinically significant prostate cancer (csPCa) compared with TRUS-guided systematic biopsy (TRUS-GB).Methods: This retrospective study focused on patients who underwent mpMRI before prostate biopsy (PB) with Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) scores ≥3 and prostate-specific antigen (PSA) level between 2.5 and 20 ng/mL. Before FUS-TB, the biopsy needle position was checked virtually using three-dimensional mapping. After confirming the position of the target within the prostate, biopsy needle was inserted and PB was performed. Suspicious lesions were generally targeted with 2 to 4 cores. Subsequently, 10-12 cores were biopsied for TRUS-GB. The primary endpoint was the PCa detection rate (PCDR) for patients with PCa who underwent combined FUS-TB and TRUS-GB.Results: According to PI-RADS v2, 76.7% of the patients with PI-RADS v2 score ≥3 were diagnosed with PCa. The PCDRs in patients with PI-RADS v2 score of 4 or 5 were significantly higher than those in patients with PI-RADS v2 score of 3 (3 vs. 4, P<0.001; 3 vs. 5, P<0.001; 4 vs. 5, P=0.073). According to PCDR, the detection rates of PCa and csPCa in the FUS-TB were significantly higher than that in the TRUS-GB.Conclusions: Following detection of suspicious tumor lesions on mpMRI, FUS-TB use detects a higher number of PCa cases compared with TRUS-GB.

Clinical Predictors of Grade Group Upgrading for Radical Prostatectomy Specimens Compared to Those of Preoperative Needle Biopsy Specimens

“…Furthermore, there was no significant difference in the GG concordance rate between TBx and SBx in surgical specimens (38.2% vs. 39.5%) in this study. Thus, this may not reflect the pathophysiology of PCa status, even though TBx may detect malignant neoplasms of the prostate with high sensitivity [ 9 , 10 ]. To date, evidence regarding their predictors remains scarce, even though many studies have evaluated the discrepancies in GG between NB and RP specimens [ 23 ].…”

“…GG was accepted by the World Health Organization for the 2016 edition of Pathology and Genetics, and the GG 1–5 terms were proposed as the new grading system by the 2014 International Society of Urological Pathology (ISUP) consensus conference [ 8 ]. Additionally, according to several guidelines, the combination of targeted biopsy (TBx) of suspicious lesions on multiparametric magnetic resonance imaging (MRI) and transrectal ultrasound-guided (TRUS) systematic biopsy (SBx) for the prostate has produced more favorable PCa detection rates than was previously possible [ 2 , 3 , 4 , 9 , 10 ].…”

“…However, discrepancies between needle biopsy (NB) specimens and radical prostatectomy (RP) specimens often occur due to sampling errors in NB or the multifocal features of PCa [ 9 , 10 , 11 ]. Several investigators reported that the discordance in GG between NB and RP specimens was observed at frequencies of 31.0–62.8% [ 12 , 13 ].…”

Alternatives for MRI in Prostate Cancer Diagnostics—Review of Current Ultrasound-Based Techniques

“…Several recent studies have demonstrated the advantage of FBx over SBx in the detection of csPCa [11,[26][27][28][29][30][31]. In 2018, Kasivisvanathan et al reported the randomized controlled trial of 500 men with PCa suspicion, randomly assigned for FBx or SBx-the PRECISION trial [11].…”

Alternatives for MRI in Prostate Cancer Diagnostics – Review of Current Ultrasound-Based Techniques

“…Several recent studies have demonstrated the advantage of FBx over SBx in the detection of csPCa [11,[26][27][28][29][30][31]. In 2018, Kasivisvsanathan et al reported the randomized controlled trial of 500 men with PCa suspicion, randomly assigned for FBx or SBx -the PRE-CISION trial [11].…”