The Possibility of Improving the Diagnosis of Clinically Significant Prostate Cancer Based on 3D-Modeling Fccording to the Results of MRI
Authors: Demchenko N. S. , Iozefi D. Ya. , Vinidchenko M. A. , Shevchenko A. N. , Frantsiyants E. M. 
Published: December 2023

Introduction: In oncourology it is important not only to detect prostate cancer, it is necessary to detect a tumor with a potential for death. Multiparametric magnetic resonance imaging (mpMRI) before prostate biopsy is necessary to improve the detection of clinically significant prostate cancer.

   Purpose: To assess the feasibility of using targeted prostate biopsy based on the developed original approach of cognitive biopsy, involving the use of three-dimensional models based on MRI data.

   Material and methods: From 2017 to 2021, a systemic transrectal biopsy of the prostate gland was performed in 126 patients at the NMRC of Oncology, supplemented by a cognitive MRI targeted biopsy. As a control group, the study included 115 patients with traditional transrectal biopsy performed at the NMRC Oncology in 2017-2020. Before the biopsy, all patients underwent MRI. The obtained MRI data of the main group processed at the workstation, after which models of the prostate gland, the alleged tumor process, were built according to the methodology developed by us.

   Results: After performing a transrectal prostate biopsy on the basis of 3D models, histological results were compared with the MRI data performed on all patients before the biopsy. Among 126 patients of the main group, the changes in MRI using the PI-RADS v2.1 system distributed as follows: in 48 patients, the PI-RADS score was 3 points, in 32 — 4 points, in 46 — 5 points. Among 115 patients of the control group, the changes in MRI using the PI-RADS 2.1 system distributed as follows: in 44 patients, the PI-RADS score was 3 points, in 26 — 4 points, in 45 — 5 points. Among patients with 3 points on the PI-RADS scale who underwent biopsy using the cognitive FUSION method, prostate cancer was diagnosed in 7 patients (14.5 %), in 19 patients (59.4 %) with 4 points on PI-RADS and in 38 patients (82.6 %) with a value of PI-RADS 5. Clinically significant prostate cancer was detected in 4 patients  (8.3 %) with 3 PI-RADS scores. Among patients with PI-RADS 4 — clinically significant prostate cancer found in 11 (34.4 %). In patients with PI-RADS 5, clinically significant prostate cancer detected in 33, which was 71.7 %. With the traditional biopsy technique, out of 115 invasive procedures, prostate cancer was detected in 41 patients (35.6 %), clinically significant prostate cancer was detected in 22, which was 19.1 %. Among 44 patients of the control group with 3 points on the PI-RADS scale who underwent a traditional biopsy, prostate cancer was diagnosed in 6 patients (13.6 %), in 12 patients (59.4 %) with 4 points on PI-RADS and in 23 patients (51.1 %) with a PI-RADS value of 5. Clinically significant prostate cancer detected in 2 patients (4.5 %) with 3 PI-RADS scores. Among patients with PI-RADS 4 — clinically significant prostate cancer was found in 5 (19.2 %). In patients of the control group with PI-RADS 5, clinically significant prostate cancer detected in 15 cases, which was 33.3 %.

   Conclusions: Transrectal prostate biopsy using 3D modeling based on multiparametric magnetic resonance imaging (MRI) with the marking of foci according to PI-RADS v2.1 makes it possible to effectively identify areas with a high probability of clinically significant cancer. The use of 3D models based on multiparametric MRI makes it possible to reasonably plan a targeted biopsy scheme and improve the diagnosis of clinically significant prostate cancer.