Prospective analysis of transperineal MRI-US fusion targeted prostate biopsy with extended systematic biopsy under local anaesthesia in office setting

Abstract

Objective: Transperineal MRI-ultrasound fusion prostate biopsy has been increasingly performed under local anaesthesia in our centre. This is a prospective study to compare the diagnostic yield between fusion targeted biopsy (FTB) and extended systemic biopsy (ESB), to review the diagnostic accuracy of mpMRI and complications of the procedure. Patients & Methods: Men with elevated PSA who had at least one PIRADS ≥ 3 lesion in mpMRI were recruited to FTB with transperineal approach, together with ESB (18 to 24 cores) according to the modified Ginsburg protocol under local anaesthesia. Results: From July 2018 to July 2019, 80 men with 140 MRI lesions were studied. Overall cancer detection rate (CDR) was 33.8% (27 patients), of whom 55.56% (15 patients) were csPCa. Sensitivity of FTB for csPCa was 86.67% (13/15). Of the 12 non-cs PCa, 3 were diagnosed by both ESB & FTB, 8 were diagnosed by ESB alone and 1 by FTB alone. The Kappa coefficient was 0.706 (p < 0.0001). Overall CDR for PIRADS 3, 4 and 5 were 10.5%, 43.75% and 90% respectively. No patient was complicated with post-biopsy sepsis. Conclusion: Transperineal fusion prostate biopsy under local anaesthesia is safe while targeted biopsy alone was highly sensitive in detecting csPCa and could avoid over-diagnosis of most non-csPCa.