Transperineal Versus Transrectal Targeted Biopsy with Use of Electromagnetically-Tracked MR/US Fusion Guidance Platform for the Detection of Clinically Significant Prostate Cancer - Beyond the Abstract

Currently, there is no consensus with respect to the optimal platform or approach for performing targeted prostate biopsies. Whereas many investigators have previously compared transperineal (TP) and transrectal (TR) approaches across a variety of biopsy indications, this is the first study to compare TP and TR targeted biopsies using the same fusion biopsy platform (UroNav, Philips Healthcare) and mpMRI protocol. These technical consistencies reduce variability in image registration error, biopsy tracking, and MRI interpretation between the groups in order to minimize potential confounding and strengthen the ability to make fair comparisons between the approaches.

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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