Diagnostic accuracy of targeted magnetic resonance imaging and ultrasound fusion biopsy and systematic biopsy in the patients with prostate specific antigen in grey area

Abstract

Objective To investigate the diagnostic accuracy of magnetic resonance imaging and ultrasound (MRI/US) fusion targeted biopsy (TB) and systematic biopsy (SB) in the patients with prostate specific antigen (PSA) in grey area. Methods The patients who received MRI/US fusion TB and SB in the First Affiliated Hospital of Soochow University between October 2015 and March 2018 were retrospectively reviewed. Eligibility criteria included: tPSA ranged 4 to 10 ng/ml ; prebiopsy MRI found at least 1 suspected lesion ; no prostate-related treatment history ; no prostate biopsy history. A total of 93 patients were invloved. The median age, tPSA and prostate volume were 66 (30-85) years, 7.18(4.11-9.95)ng/ml and 42.01(14.93-119.15)ml, respectively. Prebiopsy MRI found 136 suspected lesions, with the median PI-RADS of 3 (3-5) and lesion size of 7 (3-20) mm. All patients underwent MRI/US fusion TB followed by SB. The comparison of two protocols in detecting any prostate cancer (PCa) as well as clinically significant prostate cancer (CsPCa) were analyzed. Results Cancer detection rates for PCa in TB [34.40%(32/93)] was not different with SB [36.55%(34/93), P=0.759] . There was no significant difference in the detection rate of CsPCa between TB and SB [20.43% (19/93) vs. 24.73% (23/93), P=0.483]. A total of 1 374 biopsy cores were sampled, among which 266 were TB cores and additional 1 108 were SB cores. The positive rate of TB cores [24.81%(66/266)] was significantly higher than SB cores [9.84% (109/1 108) , P<0.001]. Conclusions In the patients with PSA in grey area, MRI/US fusion TB achieved similar cancer detection rate compared with SB using only few biopsy cores. Therefore, TB was appropriate for patients with MRI suspicions. Moreover, combination of TB with SB can achieve the highest cancer detection rate. Key words: Prostatic neoplasms; Magnetic resonance imaging; Ultrasound; Targeted biopsy; Systematic biopsy; Prostate specific antigen grey area