Computed tomography-guided pararectal prostate fusion biopsy

Abstract

Background . Prostate cancer (PCa) is one of the most common malignancies. The gold standard of PCa diagnostics is morphological examination of prostate tissues obtained using 10-12-core biopsy. However, the number of false-negative results and detected clinically insignificant forms of cancer remain high. Magnetic resonance imaging (MRI) is the most sensitive and specific method of radiation diagnosis of PCa. The use of MRI data for prostate biopsy (fusion-biopsy) increases the accuracy of this procedure. Objective : to increase the accuracy of PCa diagnostics using targeted pararectal prostate biopsy guided by computed tomography (CT)/MRI. Materials and methods . A total of 95 patients underwent CT/MRI-guided targeted pararectal biopsy between March 2015 and March 2020. The mean level of prostate specific antigen (PSA) was 13.7 ± 12.6 ng/mL. All men were found to have 1 to 3 lesions with a PI-RADS score between 3 and 5. Patients were divided into 4 groups: 1 st group (n = 33) included patients in whom transrectal access was impossible; 2 nd group (n = 22) included patients with suspected local recurrence of PCa after brachytherapy; 3 rd group (n = 28) included patients with a negative result of primary biopsy, but with growing PSA level; 4th group (n = 12) included patients who preferred targeted biopsy. We performed targeted biopsy of each suspicious lesion according to MRIscans. Then we performed ‘blind’ systematic 10-14-core biopsy, where we did not take into account the location of suspicious foci and they could be, therefore, accidentally used for sample collection for the second time. Results . Histological examination revealed PCa in 71 out of 95 patients (74.7 %): in 27 out of 33 in 1 st group (81.8 %), in 19 out of 22 in 2 nd group (86.4 %), in 17 out of 28 in 3 rd group (60.7 %), and in 8 out of 12 in 4 th group (66.7 %). In 21 patients (29.6 %), PCa was diagnosed only in samples obtained using targeted biopsy; in 9 patients (12.7 %), PCa was diagnosed only in samples after systematic biopsy; in 41 patients (57.7 % PCa was detected by both targeted and systematic biopsy. Clinically significant cancer (Gleason score ≥7) was diagnosed in 84.5 % of cases after targeted biopsy and in 70.4 % of cases after systemic biopsy. Conclusion . CT/MRI-guided prostate fusion biopsy increases the accuracy of PCa diagnostics by additional detection of clinically significant tumors, including those in patients in whom the rectal access is impossible.