Effectiveness of Magnetic Resonance Imaging/Ultrasound-Guided Target Biopsy in Detecting Clinically Significant Prostate Cancer

Abstract

Abstract Background We aimed to evaluate the effectiveness of magnetic resonance imaging/ultrasound (MRI-US)-guided fusion biopsy for the detection of clinically significant prostate cancer (CSPC) and analyze the features of those highly suspected of having PCa but shown to be negative in target biopsies (TB) in patients with prostate imaging reporting and data system (PI-RADS) 4 or 5 lesions on multiparametric MRI evaluations. Methods We retrospectively evaluated all patients who underwent MRI/transrectal ultrasound (TRUS)-guided fusion biopsies at our institution between April 2018 and April 2022. All patients with at least one PI-RADS 3 or higher lesions and prostate-specific antigen (PSA) ≤ 20 ng/mL were enrolled in our study and subjected to TB in the region of interest. CSPC was defined as grade group ≥ 2 (equivalent to a Gleason score of 3 + 4). Results The detection rates of CSPC were higher in patients who underwent systematic biopsy (SB) and TB (54%; 177/328) than in those who underwent SB alone (39%; 128/328). Statistically significant differences were noted in the detection of CSPC depending on age, prostate volume, PI-RADS score, PSA density (PSAD), number of biopsies obtained, lesion location, and ROI. Conclusion MRI/TRUS-guided fusion prostate biopsy increased the detection rate of CSPC. PCa was less likely to be detected in patients with a low PSAD, large prostate volume, past history of biopsies, and no family history among those with PI-RADS 4 or 5 lesions and should be considered in such patients and addressed by performing additional SB for improving the detection rate of CSPC.