Efficacy of Magnetic Resonance Imaging/ Ultrasound-Guided Target Biopsy in Detecting Clinically Significant Prostate Cancer
Authors:   Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria, Gatsev Ognyan , Todorova Viktoria ,   Clinic of Urology, Clinic of Nephrology, 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, Petrova Daniela ,   Clinic of Nephrology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
Published: June 2024

Introduction: Prostate cancer remains a formidable health challenge, demanding diagnostic strategies that balance accuracy and invasiveness. To enhance early detection and accurate risk stratification, various diagnostic methods have been developed. Magnetic Resonance Imaging (MRI) is considered the standard imaging modality for the detection and localization of prostate cancer. Prostate Imaging Reporting and Data System (PI-RADS) is a standardized system that assigns scores to suspicious lesions based on MRI findings. This system helps distinguish the likelihood of clinically significant prostate cancer (CsPCa), guiding clinicians in decision-making. Magnetic Resonance Imaging/Ultrasound-Guided fusion target biopsy (MRI/US) has emerged as a promising technique in diagnosis of prostate cancer, fusing advanced imaging modalities with real-time ultrasound guidance. Material and methods: A retrospective study was carried out from January 2019 to June 2023. Patients included in the study had elevated tPSA levels and underwent MRI of the prostate. MRI findings were characterized on the basis of PIRADS grading. All patients with a score equal or higher than PI-RADS 3 underwent MRI/US-guided fusion target biopsy. The histopathological results were retrospectively analyzed. Results: 375 patients were included in the study. The mean age of the patients in our study was 67.8 ± 8.2 years. tPSA levels ranged 17.21 ± 31.36 ng/ml and mean prostate volume was 52.67 ± 19.6 cc. 87.5 % of the patients had a negative rectal digital exam and 12.5 % had a positive one. 29.4 % of the MRI exams had lesions scored as PI-RADS 3, 47.1 % – as PI-RADS 4 and 22.5 % as PI-RADS 5. 67.1 % of detected lesions were located in the peripheral zone, 26.5 % – in the transitional zone, 4.5 % in the anterior zone and 1.6% of the lesions were apical. 35.7 % patients had a negative for carcinoma histopathological result and were diagnosed with benign prostatic hyperplasia; 39.2 % of the histopathological results were classified as low grade prostate carcinoma and 29.5 % as high grade prostate carcinoma. All results were classified according to the Gleason score. 30.1 % were Gleason score 3+3=6, 25.1 % were Gleason 7 (13.1 % as Gleason 3+4 and 12 % as 4+3), 5.1 % were Gleason 8 and 5.6 % were Gleason 4+5 or 5+4. Conclusion: The integration of MRI/US fusion biopsy into the diagnostic pathway has significantly improved the detection and characterization of clinically significant prostate cancer. This approach enables more personalized and precise management strategies for patients with prostate cancer.