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New England Section of the American Urological Association

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Transperineal multiparametric magnetic resonance imaging-ultrasound fusion targeted prostate biopsy improves cancer detection over in-office transperineal template biopsy
Michelle Kim, MD PHD, Shulin Wu, MD, Sharon Lin, PhD, Rory Crotty, MD, Mukesh Harisinghani, MD, Chin-Lee Wu, MD PhD, Douglas Dahl, MD.
MGH, Boston, MA, USA.

ABSTRACT Introduction: Transperineal (TP) prostate biopsy provides an effective approach to prostate cancer detection. The improvement over the standard template with multiparametric MRI (mpMRI) imaging guidance for TP prostate biopsy has yet to be examined in a large cohort of patients. Methods: We identified all men who underwent in-office transperineal biopsy with mpMRI fusion guided software from September 2019 to February 2021 using the Precision Point device and UroNav guidance platform. We assessed clinicopathological factors, MRI and biopsy characteristics. We compared pathological results between standard transperineal biopsy template and targeted biopsies.Results: Three hundred and one (n=301) men underwent concomitant standard template and targeted biopsy procedures. The median age was 67(IQR, 62-73), and the median PSA was 6.0 ng/mL (IQR, 4.4-8.8). The median prostate volume by MRI was 45 cc (IQR, 33-61), and the median PSA density was 0.14 ng/mL/cc (IQR, 0.09-0.20). Twenty cores constituted the standard template biopsy set. Target lesions on MRI were sampled with 3 targeted cores per patient (IQR 34). The overall prostate cancer detection rate was 74.1% and 63.5% by standard template and targeted biopsy, respectively, of which 52.5% and 59.9% were clinically significant prostate cancer, respectively. Targeted biopsies missed 19.8% of cancer cases while templated biopsies missed 6.3% of cancer cases (p<0.001). Templated biopsies showed significantly higher cancer detection rate than the target biopsy (p<0.001) but slightly lower clinically significant cancer detection rate (p=0.662). Of 176 cases with combined overall cancer diagnosis, 18.8% had an upgraded Gleason score (GS) with targeted biopsies while 18.2% cases were upgraded with the standard template.Conclusion: Transperineal MRI guided fusion biopsy combined with the standard template provides a higher detection rate of clinically significant prostate cancer in men with suspicious lesions than the standard template alone and should be included as part of the biopsy procedure.


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