Fusion‐targeted biopsy significantly improves prostate cancer detection in biopsy‐naïve men

Abstract

ObjectiveThe precise diagnosis of prostate cancer (PC) is crucial to avoid underdiagnosis, overdiagnosis, and overtreatment. We aimed to compare clinically significant PC (csPC) detection between MRI/ultrasound fusion‐targeted prostate (TBx) compared to systematic biopsy (SBx) in biopsy‐naïve Japanese men.MethodsWe included patients with suspect PC due to elevated PSA level or abnormal digital rectal examination, or both. csPC was defined as International Society Urological Pathology (ISUP) grade group ≥2 (csPC‐A) and ISUP grade group ≥3 (csPC‐B).ResultsThis study included 143 patients. Overall PC detection was 66.4% for SBx and 67.8% for MRI‐TBx. MRI‐TBx presented a significantly higher rate of csPC detection (csPC‐A 67.1% vs. 58.7%, p = 0.04, and csPC‐B 49.6% vs. 39.9%, p < 0.001) and significantly lower detection of non‐csPC‐A (0.6% vs. 6.7%). Importantly, MRI‐TBx missed 4.9% (7/143) of csPC‐A and only 0.7% (1/143) of csPC‐B. On the other hand, SBx alone missed 13.3% (19/143) of csPC‐A and 4.2% (6/143) of csPC‐B.ConclusionMRI‐TBx significantly outperformed 12‐cores SBx for csPC detection and decreased non‐csPC detection in biopsy‐naive men. Performing MRI‐TBx without SBx would have missed some csPC, supporting that MRI‐TBx synergizes with SBx to increase csPC detection.