Comparison of systematic transrectal biopsy to transperineal MRI/ultrasound-fusion biopsy for the diagnosis of prostate cancer - Abstract

OBJECTIVES: To compare targeted, transperineal MRI/ultrasound-fusion biopsy to systematic transrectal biopsy in patients with previous negative or first prostate biopsy.

To evaluate the gain in diagnostic information with systematic biopsies in addition to targeted MRI/ultrasound-fusion biopsies.

PATIENTS AND METHODS: 263 consecutive patients with suspicion of prostate cancer (PCa) were investigated. All patients were evaluated by 3 Tesla multiparametric magnetic resonance imaging (mpMRI) applying the European Society of Urogenital Radiology (ESUR) criteria. All patients underwent MRI/ultrasound-fusion biopsy transperineally (mean nine cores) and additionally a systematic transrectal biopsy (mean 12 cores).

RESULTS: 195 patients underwent repeat biopsy and 68 patients underwent first biopsy. Median age was 66yrs, median PSA-level was 8.3ng/mL, median prostate volume was 50mL. Overall, PCa detection rate was 52% (137/263). MRI/ultrasound-fusion biopsy detected significantly more PCa than systematic prostate biopsy (44% (116/263) vs. 35% (91/263); p=0.0023). In repeat biopsy, the detection rate was 44% (85/195) in targeted and 32% (62/195) in systematic biopsy (p=0.0023). In first biopsy, the detection rate was 46% (31/68) in targeted and 43% (29/68) in systematic biopsy (p=0.5271). 80% (110/137) of biopsy-proven PCa were clinically significant. Regarding the upgrading of Gleason Score (GS), 44% (32/72) more clinically significant PCa was detected by using additional targeted biopsy compared to systematic biopsy alone. Conversely, 12% (10/94) more clinically significant cancer was found by systematic biopsy additionally to targeted biopsy.

CONCLUSIONS: MRI/ultrasound-fusion biopsy was associated with a higher detection rate of clinically significant PCa while taking fewer cores both, especially in patients with prior negative biopsy. Due to a high portion of additional tumours with GS ≥ 7 detected in addition to targeted biopsy, systematic biopsy should still be performed additionally to targeted biopsy.

Written by:
Borkowetz A, Platzek I, Toma M, Laniado M, Baretton G, Froehner M, Koch R, Wirth M, Zastrow S.   Are you the author?
Department of Urology, Technische Universität, Dresden, Germany.

Reference: BJU Int. 2014 Dec 18. Epub ahead of print.
doi: 10.1111/bju.13023

PubMed Abstract
PMID: 25523210 Prostate Cancer Section