Diagnosis of Clinically Significant Prostate Cancer – Efficacy of MRI / Ultrasound Fusion Targeted Biopsy
Authors:   Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria, Todorova Viktoria , Gatsev Ognyan ,   Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria, Hristov Konstantin ,   Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria, Petkova Kremena ,   Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria, Saltirov Iliya ,   Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria, Mihaylova Maria ,   Department of Nuclear Medicine, Specialized University Hospital for Active Treatment of Oncology “Prof. Ivan Chernozemski”, Sofia, Bulgaria
Published: December 2024

Introduction: Diagnosis of prostate cancer remains a challenge, requiring methods that balance accuracy and invasiveness. To improve early diagnosis and risk assessment for clinically significant disease, new diagnostic methods have been developed and implemented over time. Magnetic resonance imaging (MRI) has become the standard among imaging techniques for diagnosing prostate cancer. The standardized system Prostate Imaging Reporting and Data System (PI-RADS) categorizes lesions suspected of prostate cancer based on MRI results, determining the likelihood of clinically significant disease. MRI/ultrasound fusion targeted biopsy is a promising method for histological diagnosis of prostate cancer, combining images from specialized imaging with those obtained in real-time via ultrasound examination.

Materials and Methods: A retrospective study was conducted on the medical data of 380 consecutive patients from January 2020 to July 2023. The patients included in the study had elevated total prostate-specific antigen (tPSA) levels. All underwent MRI of the prostate gland. MRI lesion data were categorized using the PI-RADS v2.1 system. For all patients with lesions rated PI-RADS 3 or higher, MRI/US-guided fusion targeted biopsy of the prostate was performed. The obtained histopathological results were statistically analyzed.

Results: The average age of the patients in the study was 65.7 ± 7 years. tPSA values were 31.36 ± 7.21 ng/ml, and the average prostate volume was 53.6 ± 15.4 cc. Digital rectal examination did not detect suspicious changes in the prostate in 74.6% of patients, while 25.4% showed suspicious changes. 32.4% of the MRIs revealed PI-RADS 3 lesions, 47.7% PI-RADS 4, and 19.9% PI-RADS 5. 56.2% of the MRI-detected lesions were located in the peripheral zone of the prostate, 28.4% in the transitional zone, 9.5% in the fibromuscular zone, and 5.9% were apical. 25.4% of patients had negative histopathological results for carcinoma and were diagnosed with benign prostatic hyperplasia; 49.2% of patients had histopathological results indicating low-grade prostate cancer, and 25.4% had high-grade prostate cancer. For all positive carcinoma results, the Gleason score was determined. 29.1% of the histopathological results were Gleason score 3+3=6, 27.1% were Gleason 7 (13.1% – Gleason 3+4 and 14% – 4+3), 7.1% were Gleason 8, and 8.6% were Gleason 4+5 or 5+4.

Conclusion: The introduction of MRI/US fusion biopsy as a diagnostic method has significantly improved early detection of clinically significant prostate cancer. The results achieved with this method allow for precise staging of the disease and personalization of strategies for subsequent treatment of patients with prostate cancer.