Introduction & Objectives: MRI-TRUS Fusion biopsy might be a convenient technique to perform a targeted biopsy of a multiparametric prostate MRI (mpMRI) suspicious area, since “cognitive” targeted biopsy has low costs but low precision and MRI “in-bore” biopsy has high precision but high costs. Purpose of our study was to investigate the outcomes of a electromagnetic synchronized real-time MRI-TRUS Fusion targeted prostate biopsy (MRI-TRUS TB) platform compared with standard systematic biopsy (SB) to diagnose prostate cancer (PCa).
Materials & Methods: Enrollment started in October 2015, patients (Pts) with a raised PSA serum level and at least a suspicious area at a preliminary mpMRI (1.5T magnet with endorectal coil) underwent to MRI-TRUS TB using a real-time software-based synchronization with electromagnetic tracking system (Toshiba Aplio 500Tm); then a SB was performed. Clinically significant Prostate Cancer (csPCa) was defined by the presence of Gleason Score (GS) ≥ 4 pattern.
Results: The clinical, radiologic, and pathologic characteristics are listed in Table 1. Of 94 Pts, 29 (30.8%) were biopsy-naïve, 50 (53.2%) had at least 1 previous negative set of random TRUS-GB and 15 (16.0%) were AS Pts for indolent PCa (GS 3+3 in ≤2 cores with a PSA level <10 ng/mL). Median age was 68 years (IQR, 62-72) and median prebiopsy PSA was 7.1 ng/ml (IQR, 5.9-9.9). At the prebiopsy mpMRI, 121 suspected lesions were identified, and 94 index lesions were scheduled for MRI-TRUS TB. Median number of targeted cores per patient was 6 (IQR, 4-6). MRI-TRUS TB were positive in 63 of 94 Pts with a Detection Rate (DR) of 67% while SB revealed a DR of 43.6% (41/94, p=0.04). Moreover, a significantly higher DR was obtained in terms of csPCa between MRI-TRUS biopsy and TRUS-GB (54.3% vs 25.5%, respectively; p=0.005) with a concomitant more accurate GS stratification (Table 2). In Pts with an index lesion PI-RADS-v2 score of 3, 4, and 5, DR for PCa were 43.2% (16/37), 83.0% (39/47) and 80.0% (8/10), respectively (p<0.001); of these cases, 9 (9/16; 56.3%), 35 (35/39; 89.7%), and 7 (7/8; 87.5%) were csPCa, respectively (p<0.001). (table 3)
Conclusion: In our experience, our real-time electromagnetic synchronized system for MRI-TRUS fusion targeted biopsy of prostate (Toshiba Aplio 500Tm) showed a superior accuracy and efficacy both in terms of diagnosis (either of PCa and csPCa) and GS stratification compared to SB.
