Prostate cancer detection rate using MRI/ultrasound fusion-guided prostate biopsy in Siriraj Hospital

Abstract

Objective: Systematic transrectal ultrasound (TRUS) guided biopsy has been considered a gold standard for prostate cancer diagnosis for many decades. The problem of this conventional method is the low detection rate especially in the case of repeat biopsy. This results from a limitation associated with ultrasound imaging inhibiting the visualization of cancerous lesions during the procedure. More recently, there has been increasing importance attributed to the use of multiparametric MRI for the identification of cancer inside the prostate gland. Targeted prostate biopsy, using multiparametric MRI/ultrasound (mpMRI/US) fusion-guided technology helps improve the detection of prostate cancer and has become a novel standard for tissue diagnosis. This study was conducted to investigate and report on the cancer detection rate of mpMRI/US fusion guided prostate biopsies at Siriraj Hospital. Materials and Methods: Data pertinent to patients who underwent mpMRI/US fusion guided biopsy at Siriraj Hospital between September 2017 and December 2019 was retrospectively reviewed. Results: A total of 499 men underwent mpMRI/US fusion guided biopsy, with the transperineal approach being used in the vast majority of cases (91.8%). Targeted biopsy provides a better cancer detection rate than systematic biopsy (55.3% vs 47.1%, p = 0.009). Combined targeted and systematic biopsies improved cancer detection rate compared to systematic biopsy alone (60.3% vs 47.1%, p < 0.001). A subgroup analysis of men with positive biopsies showed that detection of clinically significant cancer (Gleason grade group ≥ 2) was no different between targeted and random biopsies (87.2% vs 80.8%, p = 0.11). The common complications from transperineal approach were urinary retention (5.4%) and hematuria (5.2%) while complications of infection were rare (0.2%). Conclusion: We found that targeted biopsy with mpMRI/US fusion guided technology provides a more effective option for prostate cancer diagnosis. A combination of targeted and systematic biopsy improve prostate cancer detection rate more effectively than systematic biopsy alone. The transperineal approach is a safe and effective technique with a rare incidence of infectious complications.