Multiparametric MRI/TRUS Fusion Prostate Biopsy: Advantages of a Transperineal Approach

Abstract

Background/aim: To evaluate the detection rate for clinically-significant prostate cancer (PCa) of transperineal (TP) vs. transrectal (TR) multiparametric MRI/TRUS (magnetic resonance imaging/transrectal ultrasound) fusion targeted-biopsy.

Patients and methods: From January 2016 to December 2016, 150 men underwent repeat saturation transperineal prostate biopsy (SPBx; median 30 cores) combined with targeted mpMRI/TRUS TR and TP fusion biopsies (4 cores for each procedure) of suspicious MRI lesions (PI-RADS 3/5).

Results: Overall, in 55/150 (36.6%) men a clinically-significant PCa was found and in 49 (89.1%) of them mpMRI was positive. SPBx, mpMRI/TRUS TR and TP fusion targeted-biopsy diagnosed 52 (94.5%), 43 (78.1%) and 49 (89.1%) PCa, respectively; TR fusion biopsy missed 8 (53.3%) while TP missed 2 (13.3%) cancers of the anterior zone.

Conclusion: Multiparametric MRI/TRUS TP in comparison to TR fusion biopsy detected a greater percentage of small but clinically significant PCa of the anterior zone (86.7% vs. 46.7%; p=0.0001).

Keywords: Prostate cancer; multiparametric MRI; saturation prostate biopsy; transperineal fusion biopsy; transrectal fusion biopsy.