Multi-parametric magnetic resonance imaging/ultrasound fusion-guided prostate biopsy significantly improves cancer detection in the Chinese population

Abstract

Introduction and objectives: Conventional transrectal ultrasound(TRUS)-guided 12-core systematic biopsy (SB) of the prostate is ablind procedure with problems of missing clinically significant cancers and over-detection of indolent prostate cancers. Multi-parametric Magnetic Resonance Imaging (mpMRI)/Ultrasound (US) fusion-guidedbiopsy is a new technology to improve the diagnostic accuracy, butAsian results are lacking. The objective of the current study is tocompare the diagnostic efficacy and complication outcome of MRI/USfusion-guided biopsy with conventional TRUS-guided SB of the prostate in a Chinese cohort. Materials and methods: From July 2015 to December 2016, men with elevated serum prostate-specific antigen (PSA) of 4–20 ng/mLwere counselled for mpMRI of the prostate to detect any lesionsaccording to the Prostate Imaging – Reporting and Data System (PI-RADS) (Version 2). Those with PI-RADS 2–5 lesions underwenttargeted biopsy (TB) plus 12-core SB using the ArtemisâMRI/USfusion platform system. The biopsy outcomes where compared with amatched cohort of 250 patients who underwent conventional TRUS-guided SB in the same period. Complication rates including sepsis,retention of urine and haematuria after the procedure were compared. Results: A total of 147 patients had pre-biopsy MRI performed, with an average of 1.7⊥0.9 MRI lesions/patient were detected in 132 patients.15 patients with negative MRI had no cancer detected on SB. 30 patientswith PI-RADS 2 lesion(s) only on MRI also had no cancer detected in bothTB and SB. In 102 patients having lesions of intermediate to highsuspicion (PI-RADS 3–5), the overall cancer detection rate by fusionbiopsy (TB+SB) was significantly higher than the conventional SB group(37.3 vs 17.6%, P < 0.0001). TB alone detected more clinicallysignificant cancers (19.6% vs 10.4%, P = 0.02) and yielded significantlylonger mean cancer core length (6.8 ⊥ 5.6 mm vs 3.6 ⊥ 3.1 mm,P = 0.004). TB alone would have avoided diagnosis of 71.4% (10/14) ofthe clinically insignificant cancers at the expense of missing 16.7% (4/24) of the clinically significant cancers. The overall complication rate waslower in the fusion biopsy group (9% vs 20.4%, P = 0.004). While sepsisrate (0.8% vs 3.2%, P = 0.13) and retention of urine (4.5% vs 1.6%,P = 0.09) were similar in the two groups, haematuria was less frequent(3.8% vs 14%, P = 0.002) in the fusion biopsy group. Conclusion: Multiparametric MRI/US fusion prostate biopsysignificantly improves the cancer detection rate of clinically significant prostate cancer in the Chinese population. It is a promising and safe new modality in prostate cancer diagnosis.