Transperineal vs transrectal MRI/TRUS fusion targeted biopsy: detection rate of clinically significant prostate cancer

Introduction To evaluate the detection rate for clinically significant PCa of transperineal (TP) vs transrectal (TR) multiparametric MRI/TRUS fusion targeted biopsy . Materials and Methods From January 2015 to January 2016 200 men (median age 61 years) with negative digital rectal examination underw...

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Bibliographic Details
Published in:Clinical genitourinary cancer 2016
Main Authors: Pepe, Pietro, Garufi, Antonio, Priolo, Giandomenico, Pennisi, Michele
Format: Article
Language:English
Subjects:
Hematology, Oncology and Palliative Medicine
Urology
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Summary:Introduction To evaluate the detection rate for clinically significant PCa of transperineal (TP) vs transrectal (TR) multiparametric MRI/TRUS fusion targeted biopsy . Materials and Methods From January 2015 to January 2016 200 men (median age 61 years) with negative digital rectal examination underwent repeat saturation transperineal prostate biopsy (SPBx; median 30 cores) for increasing or persistent elevated PSA values. All the patients 10 day before SPBx underwent 3.0 Tesla pelvic multiparametric MRI (mpMRI) (ACHIEVA 3T; Philips Healthcare Best, the Netherlands); in the presence of mpMRI lesions suggestive of cancer (PIRADS 4/5), targeted mpMRI/TRUS TR-fusion guided-biopsies (4 cores) and TP-cognitive biopsies (4 cores) were added to SPBx. Results Median PSA was 8.6 ng/ml and mpMRI showed a suspicious lesion in 95/200 (47.5%) cases. Overall, in 60/200 (30%) men a clinically significant PCa was found and in all the cases mpMRI was positive. SPBx, TR-fusion and mpMRI/TRUS TP-cognitive targeted biopsy diagnosed 59 (98.3%), 40 (78.3%) and 56 (93.3%) clinically significant PCa, respectively. TR-fusion vs TP-targeted biopsy missed 12 vs 1 (p= 0.001) cancers of the anterior zone and 8 vs 3 (p= 0.12) of the peripheric gland, respectively; moreover, PCa diagnosed by TR-fusion vs TP-targeted biopsy had a mpMRI lesion diameter and percentage of positive cores equal to 13 vs 10 mm and 33% vs 58% (p= 0.001), respectively. Conclusion Multiparametric MRI/TRUS TP-cognitive targeted biopsy found a greater percentage of clinically significant PCa of the anterior zone in comparison with mpMRI/TRUS TR-fusion approach (93.3% vs 25%; p= 0.0001).
ISSN:1558-7673
DOI:10.1016/j.clgc.2016.07.007