Initial Outcomes and Assessment of the Transperineal Multiparametric-Magnetic Resonance Imaging/Ultrasonography Fusion Biopsy Method in Diagnosing Clinically-significant Prostate Cancer

Abstract

Objective: In this study, it was aimed to investigate the success of transperineal multiparametric magnetic resonance imaging (mp-MRI)/transrectal ultrasonography (USG) fusion prostate biopsy method in prostate cancer diagnosis and detection of clinically significant cancer. Materials and Methods: All patients signed written informed consent then patients with an indication for prostate cancer, therefore biopsy was planned for the last year underwent 3 Tesla mp-MRI retrospectively. All the lesions of patients with Prostate Imaging, Reporting and Data System (PIRADS) 3, 4 and 5 lesions were marked using MIM (TM) Symphony software by a single radiologist. All patients underwent transperineal MRI/USG fusion biopsy under general anesthesia. In the prostate MRI evaluation of the targeted lesions with a PIRADS score of 3-4-5 were sampled with 2 to 5 cores followed by random biopsies of both of the prostate lobes. Results: Prostate adenocarcinoma was diagnosed in 20 of 59 patients (33.8\%) having fusion biopsy. No difference was observed in prostate-specific antigen levels of patients whose biopsy results were benign and malignant. In 63\% of patients, only PIRADS 3 lesions were found, whereas PIRADS 4 and/or 5 lesions were reported in 22 (37\%) patients. The fusion biopsy of PIRADS 3 lesions revealed cancer in 7 patients (19\%), of which 6 had clinically-insignificant prostate cancer criteria. Adenocarcinoma was diagnosed in 59\% who had PIRADS 4 and/or 5 lesions. All these tumors had clinically-significant cancer characteristics. Lesion-targeted fusion biopsies missed 1 clinically-insignificant adenocarcinoma (1/714.3\%), while it did not miss any of the clinically-significant cancers. No infection was seen in post-operative period. Acute urinary retention was developed in 4 patients (6\%). Conclusion: The findings in the initial period give rise to the thought that lesion targeted prostate biopsy method may have a crucial role in especially determining clinically-significant cancer. Prospective randomized studies with larger numbers of patients and especially comparison of different fusion biopsy platforms, are needed in order to assess the diagnostic success of MRI/USG fusion biopsy fully.