To analyse the detection rates of primary MRI-fusion transperineal prostate biopsy using combined targeted and systematic core distribution in three tertiary referral centres.
Multicentre, prospective outcome study of 807 consecutive biopsy-naïve patients having undergone MRI-guided transperineal prostate biopsy as the first diagnostic intervention between 10/2012 and 05/2016. MRI was reported following PI-RADS criteria. 236 patients had 18-24 systematic transperineal biopsies only, and 571 patients underwent additional targeted biopsies either by MRI-fusion or cognitive targeting if PI-RADS ≥3 lesions were present. Detection rates for any and Gleason score (GS) 7-10 cancer in targeted and overall biopsy. Predictive values were calculated for different PI-RADS and PSA density (PSA-D) groups.
Cancer was detected in 68% and GS 7-10 in 49% of patients. Negative predictive value of 236 PI-RADS 1-2 MRI in combination with PSA-D ≤0.1 ng/ml/cm(3) for GS7-10 was 0.91 (±0.07, 8% of study population). In 418 patients with PI-RADS 4-5 lesions using targeted plus systematic biopsies, the cancer detection rate of GS 7-10 was significantly higher at 71% versus 59% and 61% with either approach alone (p=0.000). For 153 PI-RADS 3 lesions, the detection rate was 31% with no significant difference to systematic biopsies with 27% (p>0.05). Limitations include variability of mpMRI reading and Gleason grading.
MRI-based transperineal biopsy performed at high volume, tertiary care centres with a significant experience of prostate mpMRI and image-guided targeted biopsies yielded high detection rates of GS 7-10 cancer. Prostate biopsies may not be needed for men with low PSA-D and a non-suspicious MRI. In patients with high probability lesions, combined targeted and systematic biopsies are recommended. This article is protected by copyright. All rights reserved.
BJU international. 2017 Oct 11 [Epub ahead of print]
N L Hansen, T Barrett, C Kesch, L Pepdjonovic, D Bonekamp, R O'Sullivan, F Distler, A Warren, C Samel, B Hadaschik, J Grummet, C Kastner
CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK., Department of Urology, University Hospital Heidelberg, DE., Australian Urology Associates and Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia., Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany., Healthcare Imaging and Monash University, Melbourne, Australia., Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, DE.