Transperineal Versus Transrectal MRI/TRUS Fusion Targeted Biopsy: Detection Rate of Clinically Significant Prostate Cancer

Abstract

IntroductionTo evaluate the detection rate for clinically significant prostate cancer (PCa) of transperineal (TP) versus transrectal (TR) multiparametric (mp) magnetic resonance imaging (MRI)/transrectal ultrasound-guided (TRUS) fusion targeted biopsy. Patients and MethodsFrom January 2015 to January 2016, a total of 200 men (median age, 61 years) with negative digital rectal examination findings underwent repeat saturation TP prostate biopsy (SPBx; median 30 cores) for increasing or persistent elevated prostate-specific antigen values. Ten day before SPBx, all patients underwent 3.0 T pelvic mpMRI (Achieva 3T; Philips Healthcare Best, Netherlands). In the presence of mpMRI lesions suggestive of cancer (Prostate Imaging—Reporting and Data System [PI-RADS] score 4/5), targeted mpMRI/TRUS TR fusion guided biopsies (4 cores) and TP cognitive biopsies (4 cores) were added to SPBx. ResultsMedian prostate-specific antigen was 8.6 ng/mL, and mpMRI revealed a suspicious lesion in 95 (47.5%) of 200 cases. Overall, in 60 (30%) of 200 men, a clinically significant PCa was found, and in all 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 versus TP targeted biopsy missed 12 versus 1 (P = .001) cancers of the anterior zone and 8 versus 3 (P = .12) cancers of the peripheric gland, respectively; moreover, PCa diagnosed by TR fusion versus TP targeted biopsy had a mpMRI lesion diameter and percentage of positive cores equal to 13 versus 10 mm and 33% versus 58% (P = .001), respectively. ConclusionmpMRI/TRUS TP cognitive targeted biopsy found a greater percentage of clinically significant PCa of the anterior zone compared to the mpMRI/TRUS TR fusion approach (93.3% vs. 25%; P = .0001).