fusion versus cognitive mri targeted prostatic biopsy

Conditions: Prostatic Cancer

Summary: the aim of the present study is to compare the accuracy of magnetic resonance imaging targeted (fusion) versus cognitive prostatic biopsy in biopsy-naïve suspected cancer prostate patient

prostate cancer is the second most frequent malignancy (after lung cancer) in men worldwide, counting 1,276,106 new cases and causing 358,989 deaths (3.8% of all deaths caused by cancer in men. the clinical prostate cancer detection rate of trus-guided needle biopsies is only 25-30%. while more than 50% of cancers that require definitive treatment remain undetected during initial biopsies . clinical studies have shown that 75-80% of non-palpable carcinomas remain undetected during initial prostate biopsies. multi-parametric prostate mri has a high sensitivity for the detection of prostate adenocarcinoma and has shown promise for targeted biopsy of lesions that may be missed on routine systematic trans -rectal ultrasound (trus) biopsy . the most recent european association of urology guidelines recommend mri before prostate biopsy for biopsy-naïve men with elevated psa, the strength rating of the recommendation is weak. a systematic 12-core trans-rectal ultrasound-guided systematic biopsy (trus-sb) is still carried out for biopsy-naïve men at present. however, the trus-sb technique has several limitations, including over-diagnosis of clinically insignificant prostate cancer (cisca), under-diagnosis of clinically significant prostate cancer (csca), false negative biopsy results and biopsy-related complications, such as bleeding and infections . targeted prostate biopsies from mri-suspicious lesions have been shown to improve the cancer detection rate (cdr) of csca compared with systematic trus-guided biopsies . currently, three biopsy techniques are used for tb from mri-suspicious lesions: in-bore mri biopsies, cognitive magnetic resonance imaging trans-rectal ultrasound fusion targeted biopsy (cog-tb) and software guided magnetic resonance imaging-ultrasound fusion targeted biopsies (mrus-tb). inbore mri biopsies that are carried out with an mri-compatible guidance device can target suspicious lesions accurately; however, such biopsies are time-consuming and expensive . in the cog-tb technique, a physician samples a location that has been visually estimated using ultrasound and is considered to correspond to the location of a suspicious lesion that was detected on mri. however, when the suspicious lesion is completely invisible (isoechoic or too small) on trus, the accuracy of such biopsies is likely reduced . the accuracy of cog-tb might be influenced by multiple factors, including the alignment of prostate landmarks, the physician's experience and so on. for these reasons, mrus-tb where software fuses the mri images with real-time trus images to guide the operator to biopsy the suspicious lesions is more commonly carried out; however, the optimal tb method remains unclear.

Eligibility criteria:
inclusion criteria: * prostate biopsy-naïve men * psa levels of up to 20 ng/ml * multi-parametric prostate mri revealed a pirad 4 or pirad 5. exclusion criteria: * psa level greater than 20 ng/ml * patient with history of trus biopsy * patient diagnosed as cancer prostate or with distant metastasis

Keywords: fusion biopsy