Transperineal versus transrectal targeted biopsy with use of electromagnetically-tracked MR/US fusion guidance platform for the detection of clinically significant prostate cancer.

To compare transperineal (TP-TBx) and transrectal (TR-TBx) targeted prostate biopsy in a prospective non randomized single surgeon series of MR/US fusion-guided targeted biopsy performed using an electromagnetic tracking platform (NCT04026763).

In this single-institution prospective study, 168 patients who underwent transperineal systematic 12-core biopsy and TP-TBx with electromagnetic tracking (UroNav, Invivo, Gainesville, FL) were compared to 211 patients who underwent a similar procedure by a transrectal approach. Univariate and multivariate analyses were used to assess if biopsy technique impacted all cancer detection rates or clinically significant (Gleason score >3+4) cancer detection rates.

Patients who underwent TP-TBx were older (68 vs 65 y, p=0.014), with a slightly higher rate of PI-RADSv2.0 score (39% vs 28%, p=0.039) and higher lesion volume on mpMRI (0.54 vs 0.41 cc, p=0.039). The rates of CS disease detection by TP-TBx and TR-TBx were 59% and 54%, respectively. In a multivariate analysis adjusting for PSA, previous biopsy status, prostate volume, PI-RADS score, lesion volume, and lesion location, there was no statistically significant difference in likelihood to detect any PCa (OR, 0.98; 95% CI, 0.56-1.71; p=0.940) or CS PCa (OR, 0.94, 95% CI, 0.58-1.51; p=0.791).

Transperineal targeted biopsy with electromagnetic-tracking is comparable to the transrectal fusion-guided approach in the detection of any PCa and csPCa cancer.

Urology. 2020 Sep 18 [Epub ahead of print]

Jared S Winoker, Ethan Wajswol, Ugo Falagario, Alberto Maritini, Erin Moshier, Nicholas Voutsinas, Cynthia J Knauer, John P Sfakianos, Sara C Lewis, Bachir A Taouli, Ardeshir R Rastinehad

Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY., Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: .