Comparison of Initial Experience with Transrectal MRI Cognitive Guided Micro-ultrasound Biopsies versus Established Transperineal Robotic Ultrasound-Magnetic Resonance Imaging Fusion Biopsies for Prostate Cancer.

We aimed to compare cancer detection rates (CDR) in patients who underwent MRI cognitive guided micro-ultrasound biopsy (MB) versus Robotic ultrasound-magnetic resonance imaging fusion biopsies (RFB) for prostate cancer (PCa).

Out of 269 targeted biopsy procedures, 222 men underwent RFB and 47 MB. RFB was performed using the transperineal Artemis device (Eigen, Grass Valley, CA), while MB was performed transrectally through high resolution ExactVu™ system (Exact Imaging, Markham, Canada). Random biopsies were performed in addition to targeted biopsy in both modalities. PCa detection rates and concordance between random and target biopsies were also assessed.

Groups were comparable regarding age, prostate-specific antigen, prostate volume and magnetic resonance PI-RADSv.2 score. MB group presented fewer biopsied cores in both random and target approaches. In targeted biopsies, MB patients presented higher detection of clinically significant disease (GS>6) than RFB group (38% vs. 23%, p=0.02). When considering PCa detection regardless of GS or PCa detection by random+target biopsies, no difference was found between the groups. However, on a per-core basis, overall PCa detection rates favoured MB patients in both random and targeted scenarios. In addition, the Prostate Risk Identification Using Micro-Ultrasound (PRI-MUS) score yielded by micro-ultrasound visualization was independently associated with improved CDR of clinically significant PCa (csPCa).

In our initial experience, MB featured a higher csPCa detection rate in target cores than RFB, which was associated to target features in micro-ultrasound (PRI-MUS score). These findings reinforce the role of micro-ultrasound technology in targeted biopsies.

The Journal of urology. 2019 Dec 10 [Epub ahead of print]

Oliver Rojas Claros, Rafael Rocha Tourinho-Barbosa, Aude Fregeville, Anna Colomer Gallardo, Fabio Muttin, Ariê Carneiro, Armando Stabile, Marco Moschini, Petr Macek, Nathalie Cathala, Annick Mombet, Rafael Sanchez-Salas, Xavier Cathelineau

Institut Mutualiste Montsouris, Paris, France., Hospital Universitari Germans Trias I Pujol, Badalona, Spain.