Primary MRI/US fusion guided biopsy of the prostate

To examine the performance of a primary MRI/ultrasound fusion guided targeted biopsy (TB) and in combination with an added systematic biopsy (SB).

Analysis of 318 consecutive biopsy naïve men with suspicious mpMRI (PI-RADS score ≥3) undergoing transrectal TB and 10-core systematic biopsy (SB) between January 2012 and December 2016. The indication for performing a mpMRI was based on clinical parameters and decided by the treating urologist prior to admittance. TB was performed with a sensor-based MRI/US fusion guided platform. Clinically significant PCa was defined as Gleason Score (GS) ≥ 4+3=7 (International Society of Urological Pathology Grade (ISUP 3)) or maximal cancer core length ≥6 mm.

A median of 14 biopsies (IQR 13-14) per case were taken. The overall cancer detection rate (CDR) was 77% (245/318). The TB alone detected 67% of prostate cancer (PCa), the SB alone detected 70%. The PI-RADS dependent CDR for the combination of TB/SB were 38% (21/55), 78% (120/154) and 95% (104/109) for PI-RADS scores 3/4/5. Clinically significant PCa was diagnosed by the combination of TB and SB in 195 men (61%) and by TB alone in 163 cases (51%). The number of missed or underestimated PCa with a GS ≥ 8 for TB alone was 31 (10%, p < 0,001) and 21 (7%, p < 0,001) for SB alone in comparison with the results of the combination of TB and SB. The rate of insignificant PCa was comparable for the combination of TB and SB and TB alone (50/318, 16% vs. 50/318, 16%).

Pre-biopsy mpMRI is of incremental value to increase the detection of clinically significant PCa in biopsy naïve patients with suspicion for PCa. Combining TB with SB further improved the diagnostic accuracy without increasing the rate of insignificant PCa. This article is protected by copyright. All rights reserved.

BJU international. 2018 Mar 22 [Epub ahead of print]

Andreas Maxeiner, Beatrice Kittner, Carsten Stephan, Thomas Fischer, Patrick Asbach, Matthias Haas, Tobias Penzkofer, Florian Fuller, Kurt Miller, Hannes Cash

Department of Urology, Charité - University Medicine, Berlin, Berlin,, Germany., Departement of Radiology, Charité - University Medicine Berlin, Berlin, Germany.