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Prospective comparison of transperineal magnetic resonance imaging/ultrasonography fusion biopsy and transrectal systematic biopsy in biopsy‐naïve patients
Author(s) -
Borkowetz Angelika,
Hadaschik Boris,
Platzek Ivan,
Toma Marieta,
Torsev Georgi,
Renner Theresa,
Herout Roman,
Baunacke Martin,
Laniado Michael,
Baretton Gustavo,
Radtke Jan Philipp,
Kesch Claudia,
Hohenfellner Markus,
Froehner Michael,
Schlemmer HeinzPeter,
Wirth Manfred,
Zastrow Stefan
Publication year - 2018
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14017
Subject(s) - medicine , biopsy , magnetic resonance imaging , prostate cancer , prospective cohort study , radiology , transrectal ultrasonography , prostate biopsy , prostate , nuclear medicine , urology , cancer , surgery
Objectives To evaluate the value of multiparametric magnetic resonance imaging (mp MRI ) in the detection of significant prostate cancer ( PC a) and to compare transperineal MRI /ultrasonography fusion biopsy (fusPbx) with conventional transrectal systematic biopsy (sysPbx) in biopsy‐naïve patients. Patients and Methods This multicentre, prospective trial investigated biopsy‐naïve patients with suspicion of PC a undergoing transperineal fusPbx in combination with transrectal sysPbx (comPbx). The primary outcome was the detection of significant PC a, defined as Gleason pattern 4 or 5. We analysed the results after a study period of 2 years. Results The study included 214 patients. The median (range) number of targeted and systematic cores was 6 (2–15) and 12 (6–18), respectively. The overall PC a detection rate of comPbx was 52%. FusPbx detected more PC a than sysPbx (47% vs 43%; P = 0.15). The detection rate of significant PC a was 38% for fusPbx and 35% for sysPbx ( P = 0.296). The rate of missed significant PC a was 14% in fusPbx and 21% in sysPbx. ComPbx detected significantly more significant PC a than fusPbx and sysPbx alone (44% vs 38% vs 35%; P < 0.005). In patients presenting with Prostate Imaging Reporting and Data System ( PI ‐ RADS ) 4 and 5 lesions there was a higher detection rate of significant PC a than in patients presenting with PI ‐ RADS ≤3 lesions in comPbx (61% vs 14%; P < 0.005). Conclusions For biopsy‐naïve men with tumour‐suspicious lesions in mp MRI , the combined approach outperformed both fusPbx and sysPbx in the detection of overall PC a and significant PC a. Thus, biopsy‐naïve patients may benefit from sysPbx in combination with mp MRI targeted fusPbx.