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