Transrectal ultrasound-guided biopsy for prostate cancer detection: Systematic and/or magnetic-resonance imaging-targeted

Abstract

Introduction: Magnetic resonance imaging (MRI) is being more widely used in the detection of prostate cancer (PCa), particularly after an initial negative biopsy. In this study, we compared 12-core systematic biopsy (SYS), MRI-targeted biopsy (TAR), and the association of systematic and MRI-targeted (SYS+TAR) prostate biopsy in patients with previous biopsy and those who were biopsy-naive to evaluate the differences in terms of cancer detection and clinically significant cancer detection between the three modalities. Methods: Overall, 203 consecutive patients with suspicion of PCa were analyzed; 48.2% were biopsy-naive and 51.7% had at least one previous negative prostate biopsy. The median age was 66 years, median prostate-specific antigen (PSA) level was 7.9 ng/mL and median prostate volume was 46 mL. 38.9% had SYS, 19.2% TAR only, and 41.8% had SYS+TAR biopsy. Results: Overall, the PCa detection (PCaDR) was 63%. The SYS+TAR biopsy detected significantly more cancer than SYS and TAR only biopsies (72.9% vs. 56.9% and 53.8% respectively; p=0.03). Detection rate of clinically significant cancer (csPCaDR) was 50.7% overall; 65.8% in the SYS+TAR biopsy vs. 39.2% in the SYS and 48.7% in the TAR groups (p=0.002). In the biopsy-naive group, PCaDR and csPCaDR were significantly higher in the SYS+TAR group than in the SYS and TAR groups (p=0.01). In the repeat biopsy group, PCaDR and csPCaDR were equivalent in the TAR and SYS+TAR groups and higher than in the SYS group (p=0.001). Conclusions: TAR biopsy, when added to SYS biopsy, was associated with a higher detection rate of csPCa in biopsy-naive patients when compared to TAR and SYS only biopsies. In patients after previous negative biopsy, detection rates of csPCa were equivalent for SYS+TAR and TAR only biopsies, but higher than SYS.

Are TRUS-guided prostate biopsies in clinical practice robust enough to make a correct assessment of the surgical strategy in prostatectomies? Poor correlation between preoperative prostate biopsies and postoperative specimens

“…Magnetic resonance imaging of the prostate might be a method that can enhance diagnostics, particularly if this is done in connection with the biopsies. It may be able to detect more potentially serious cancers, detect less low risk cancers and reduce unnecessary biopsies [8][9][10]16,17].…”

“…Furthermore, magnetic resonance imaging targeted (MRTtargeted biopsies) vs SYS have been compared. MRT-targeted biopsy, when added to SYS, was associated with a higher detection rate of clinically significant cancer in biopsy-naive patients when compared to SYS alone [8]. Siddiqui et al [9] found that MRT/Ultrasound-fusion-guided biopsy upgrades and detects prostate cancer of higher Gleason grade in 32% of patients when compared to 12-core biopsy alone.…”

Transperineal Prostate Biopsy Targeted by Magnetic Resonance Imaging Cognitive Fusion

“…Modern prostate biopsy techniques are based on the computerised 3D merging of the ultrasound and MRI images to provide better vision during the procedure (Fusion Biopsy) [ 9 , 10 ]. However, the method is expensive due to high equipment costs.…”

Multiparametric ultrasound and machine learning for prostate cancer localization

“…In clinical routine, the 12-core systematic biopsy (SBx) procedure guided by transrectal ultrasound work as the gold standard for PCa diagnosis. However, biopsies suffer from a risk of infection, the underdiagnosis of significant PCa, and overtreatment of insignificant cancer [2], [3]. Improving the diagnostic efficacy of SBx or even replacing SBx with non-invasive imaging diagnostics tools is in demand.…”