Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting-prospective single center experience after 300 cases in first biopsy setting

Emanuel Cata; Iulia Andras; Matteo Ferro; Pierre Kadula; Daniel Leucuta; Gennaro Musi; Deliu-Victor Matei; Ottavio De Cobelli; Attila Tamas-Szora; Cosmin Caraiani; Andrei Lebovici; Flavia Epure; Maria Bungardean; Radu-Tudor Coman; Nicolae Crisan

doi:10.21037/tau-20-1001

Systematic sampling during MRI-US fusion prostate biopsy can overcome errors of targeting-prospective single center experience after 300 cases in first biopsy setting

Transl Androl Urol. 2020 Dec;9(6):2510-2518. doi: 10.21037/tau-20-1001.

Authors

Emanuel Cata^{1

2}, Iulia Andras^{1

2}, Matteo Ferro³, Pierre Kadula², Daniel Leucuta⁴, Gennaro Musi³, Deliu-Victor Matei³, Ottavio De Cobelli^{3

5}, Attila Tamas-Szora⁶, Cosmin Caraiani⁷, Andrei Lebovici⁸, Flavia Epure⁹, Maria Bungardean¹⁰, Radu-Tudor Coman¹¹, Nicolae Crisan^{1

2}

Affiliations

¹ Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
² Urology Department, Municipal Hospital, Cluj Napoca, Romania.
³ Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.
⁴ Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
⁵ Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, Milan, Italy.
⁶ Radiology Department, Municipal Hospital, Cluj Napoca, Romania.
⁷ Medical Imaging Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
⁸ Radiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
⁹ Medical Imaging Department, Medisprof Cancer Center, Cluj Napoca, Romania.
¹⁰ Pathology Department, County Emergency Hospital, Cluj Napoca, Romania.
¹¹ Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.

Abstract

Background: Multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy have become an integral part of the diagnosis of prostate cancer (PCa), as recommended by the European Association of Urology Guidelines. The aim of the current study was to evaluate the performance of MRI and MRI-transrectal ultrasound (TRUS) fusion prostate biopsy as first biopsy setting in a tertiary center.

Methods: A cohort of 300 patients was included in the current analysis. All patients presented with clinical or biochemical suspicion of PCa and harbored at least one suspect lesion on mpMRI. MRI-TRUS fusion prostate biopsy, followed by 12 core systematic prostate biopsy were performed by the same operator using a rigid registration system.

Results: The mean age of the patients was 64 years (IQR: 58-68.5 years) and the mean PSA was 6.35 ng/mL (IQR: 4.84-9.46 ng/mL). Overall cancer and csPCa diagnosis rates were 47% and 40.66%. Overall PCa/csPCa detection rates were 20.4%/11.1%, 52%/45% and 68.5%/66.7% for PI-RADS lesions 3, 4 and 5 (P<0.001/P<0.0001). Larger lesion diameter and lesion volume were associated with PCa diagnosis (P=0.006 and P=0.001, respectively). MRI-TRUS fusion biopsy missed PCa diagnosis in 37 cases (of whom 48.6% ISUP 1) in comparison with 9 patients missed by systematic biopsy (of whom 11.1% ISUP 1). In terms of csPCa, systematic biopsy missed 77.7% of the tumors located in the anterior and transitional areas. The rate of csPCa was highest when targeted biopsy was associated with systematic biopsy: 86.52% vs. 68.79% for targeted biopsy vs. 80.14% for systematic biopsy, P=0.0004. In 60.6% of cases, systematic biopsy was positive for PCa at the same site as the targeted lesion. Of these patients, eight harbored csPCa and were diagnosed exclusively on systematic biopsy.

Conclusions: MRI-TRUS fusion prostate biopsy improves the diagnosis of csPCa. The main advantage of an MRI-guided approach is the diagnosis of anterior and transitional area tumors. The best results in terms of csPCa diagnosis are obtained by the combination of MRI-TRUS fusion with systematic biopsy. The systematic biopsy performed during MRI-targeted biopsy could have an important role in overcoming errors of MRI-TRUS fusion systems.

Keywords: MRI-TRUS fusion prostate biopsy; Multiparametric magnetic resonance imaging (mpMRI); prostate cancer diagnosis; systematic biopsy.