This study found that regardless of targeted biopsy approach, you are able to adequately sample a region of interest (ROI) seen on MRI. Specifically, there was no significant difference in the rate of clinically significant prostate cancer (csPCa) detection between the two approaches (TP: 59% vs. TR: 54%). This remained true after adjusting for PSA, prostate volume, previous biopsy status, ROI volume, ROI location, and ROI suspicion based on PI-RADS v2 score.
These findings are significant because they help dispel the dogma that anterior lesions are more accurately sampled transperineally when targeting with MR/US fusion guidance. As demonstrated by the study, the detection of csPCa was similar between the two approaches independent of ROI location. Therefore, MR/US fusion can be viewed as the great equalizer between TP and TR – if a ROI is seen on mpMRI, you can adequately sample it regardless of approach. Based on these findings, urologists transitioning away from TR toward TP biopsies can feel confident that they are not sacrificing diagnostic accuracy in their patients with an elevated PSA and positive mpMRI.
Written by: Jared S. Winoker, MD, Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York; Ardeshir R. Rastinehad, DO, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
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