A Prospective Comparison of MRI-Guided Targeted Biopsy with 12-Core Transrectal Ultrasound-Guided Systematic Biopsy in the Diagnosis of Clinically Significant Prostate Cancer: An Indian Experience

Abstract

Abstract Objective The aim of this study was to compare the sensitivity and prostate cancer detection rate of magnetic resonance (MR) in-bore biopsy with transrectal ultrasound (TRUS) guided systematic biopsy. We also compared the cancer detection rate of the combined MR in-bore and TRUS-guided systematic biopsy with the TRUS-guided biopsy only approach. Methods In this prospective study, 61 consecutive patients with prostate-specific antigen (PSA) ≥ 3 ng/mL and Prostate Imaging Reporting and Data System (PI-RADS) score ≥4 were recruited between July 2017 and January 2020. One patient with prior prostate surgery was excluded. Among the remaining 60 patients, 30 underwent MR in-bore biopsy followed by systematic biopsy (study arm A) and 30 underwent systematic biopsy only (study arm B). Results The mean PSA range of study population (n = 60 patients) was 4.2 to 72.7 ng/mL. Twenty-seven patients had a PI-RADS score of 4, and 33 patients had a PI-RADS score of 5. Among 60 patients, 30 had prostate carcinoma on biopsy, of which 18 were clinically significant prostate cancers (csPCa). In study arm A, TRUS-guided systematic biopsy had a lower sensitivity (0.9) for detection of csPCa compared with MR in-bore biopsy (1.0) with overdetection of insignificant cancers (sensitivity: 0.89 vs. 0.56). TRUS-guided biopsy yielded 112 positive cores out of 360, whereas MR in-bore biopsy yielded 15 positive cores out of 30 (31.1 vs. 50%; p = 0.03). On comparison of study arms A and B, the diagnostic yield for detection of both prostate cancer and csPCa were high in study arm A (60 vs. 40%, and 33.3 vs. 26.7%, respectively) Conclusion MRI in-bore targeted biopsy had a greater sensitivity to detect csPCa with fewer number of biopsy cores and lower sensitivity to detect insignificant cancers compared with systematic biopsy. Systematic biopsies were associated with overdetection of clinically insignificant cancers.