The combination of targeted and systematic prostate biopsies is the best protocol for the detection of clinically significant prostate cancer. (4th May 2018)

• Record Type: Journal Article
• Authors: Fourcade, Alexandre; Payrard, Charlotte; Tissot, Valentin; Perrouin-Verbe, Marie-Aimée; Demany, Nicolas; Serey-Effeil, Sophie; Callerot, Pierre; Coquet, Jean-Baptiste; Doucet, Laurent; Deruelle, Charles; Joulin, Vincent; Nonent, Michel; Fournier, Georges; Valeri, Antoine
• Is Part Of: Scandinavian journal of urology. Volume 52:Number 3(2018)
• Page Start: 174
• Page End: 179
• Publication Date: 2018-05-04
• Subjects: Biopsy -- diagnosis -- multiparametric MRI -- PI-RADS -- prostate cancer -- targeted biopsy; Urology -- Periodicals; 616.6
• DOI: 10.1080/21681805.2018.1438509
• Languages: English
• ISSNs: 2168-1805

Abstract

Abstract: Objective: Compared with standard systematic transrectal ultrasound (TRUS)-guided biopsies (SBx), targeted biopsies (TBx) using magnetic resonance imaging (MRI)/TRUS fusion could increase the detection of clinically significant prostate cancer (PCa-s) and reduce non-significant PCa (PCa-ns). This study aimed to compare the performance of the two approaches. Materials and methods: A prospective, single-center study was conducted on all consecutive patients with PCa suspicion who underwent prebiopsy multiparametric MRI (mpMRI) using the Prostate Imaging Reporting and Data System (PI-RADS). All patients underwent mpMRI/TRUS fusion TBx (two to four cores/target) using UroStation™ (Koelis, Grenoble, France) and SBx (10–12 cores) during the same session. PCa-s was defined as a maximal positive core length ≥4 mm or Gleason score ≥7. Results: The study included 191 patients (at least one suspicious lesion: PI-RADS ≥3). PCa was detected in 55.5% (106/191) of the cases. The overall PCa detection rate and the PCa-s detection rate were not significantly higher in TBx alone versus SBx (44.5% vs 46.1%, p = .7, and 38.2% vs 33.5%, p = .2, respectively). Combined TBx and SBx diagnosed significantly more PCa-s than SBx alone (45% vs 33.5%, p = .02). PCa-s was detected only by TBx in 12% of cases (23/191) and only by SBx in 7.3% (14/191). Gleason score was upgraded by TBx in 16.8% (32/191) and by SBx in 13.6% (26/191) of patients ( p = .4). Conclusions: The combination of TBx and SBx achieved the best results for the detection and prognosis of PCa-s. The use of SBx alone would have missed the detection of PCa-s in 12% of patients.