Transperineal fusion prostate biopsy. Diagnostic value in comparison with a standard biopsy.
Authors:   urological department with chemotherapy, P. Hertzen Moscow scientific research oncology institute – branch of the National Medical Research Center of Radiology of the Ministry of Health of Russia, Romanov R.A. ,   Moscow, Russia, Koryakin A.V. ,   Innovation Department of N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation; Moscow, Russia, Tolstov I.S. ,   Innovation Department of N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation; Moscow, Russia, Kirpatovskiy V.I. ,   N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation; Moscow, Russia, Alekseev B.Ya. ,   National Medical Research Centre of Radiology of Ministry of health of Russian Federation; Moscow, Russia
Published: April 2023

Introduction. A significant improvement in the quality of prostate imaging by magnetic resonance (MRI), as well as the possibility of combining MRI and ultrasound images (fusion technology) for biopsy, open up new possibilities for the diagnosis of prostate cancer. The arsenal of methods of treating prostate cancer includes active surveillance and focal therapy for patients with low risk disease. That raises the question of improving the accuracy of diagnosis of tumor volume, stage and differentiation, which will largely determine the tactics of patient management. The aim of our work was to determine the diagnostic effectiveness of targeted MRI-assisted fusion biopsy of the prostate in comparison with standard biopsy. Materials and methods. We analyzed data of 356 patients who underwent tranperineal fusion biopsy. The age of the patients ranged from 48 to 72 years with an average value of 68.2 ± 2.1 years. The selection criteria for the study were an increase in the level of PSA (345 patients) – the range from 4 to 44.5 ng/ml (on average 6.02±0.21) or the detection of tumor-suspicious areas during finger rectal examination or transrectal ultrasound examination (TRUS) of the prostate gland (41 patients). Further methods of examination included multiparametric magnetic resonance imaging (MRI) and subsequent transperineal fusion biopsy in combination with standart biopsy. Results. In our study, the detection rate of prostate cancer was (82.6%) – the diagnosis was confirmed in 294 out of 356 examined patients. At the same time, with an increase in the PI-RADS gradation, the frequency of histological confirmation of cancer increased: 62.4% for PI-RADS 3 lesions, 89.6% for 4 and 96.7% for PI-RADS 5. Targeted biopsies confirmed the presence of prostate cancer in 246 cases out of 356 patients (69.1%). In relation to all cases of cancer detection, the proportion of positive targeted biopsies was 83.7%. Conclusion. Targeted MRI-assisted fusion biopsy allows detecting prostate cancer in 69.1%, but when supplemented with a polyfocal biopsy at standard points, the diagnostic accuracy increases to 82.6%. Thus, the data obtained allow us to conclude that based on the examination of patients with suspected prostate cancer using mpMRI with targeted fusion biopsy, supplemented by polyfocal biopsies at standard points, it is possible to determine the localization, extent and degree of malignancy of the tumor with a high degree of certainty.