Introduction

The aim of this study was to compare the detection rate of clinically significant prostate cancer (csPCa) of different mpMRI targeted approaches and to assess the role of operator expertise on the detection of csPCa

Methods

244 patients underwent mpMRI targeted biopsy (cognitive-CB or fusion-FB) between 2013 and 2016 at a single tertiary referral centre. A 1.5 T mpMRI study using an endorectal coil was performed in all men. All procedures were performed by four operators. csPCa was defined as Gleason Score at biopsy ≥7. Operator expertise was coded as progressive number of targeted biopsies performed by each physician. Multivariable logistic regression analyses (MVA) were used to assess the association between type of targeted biopsy technique (FB vs. CB) and operator expertise (modelled by natural log function) with the detection of csPCa. Covariates consisted of PSA, prostate volume, PIRADS v.2 (3 vs. >3), number of targeted cores per MRI lesion, digital rectal examination (negative vs. positive). The same analyses were performed only in patients undergoing FB, after accounting also for type of FB approach (trans-rectal vs. trans-perineal). Lowess smoother weighted function was used to graphical assess the effect of operator expertise on the probability to detect csPCa in FB group, after accounting for all confounders

Results

Overall, 157 (64.3%) patients underwent FB and 87 (35.7%) underwent CB. Overall csPCa detection rate was 57.9 vs. 44.8% for FB and CB, respectively (p=0.07). A significantly higher csPCa detection rate of targeted samples alone was also observed for FB as compared to CB (56.7 vs. 35.6%; p=0.002). At MVA, FB and operator expertise were significantly associated with higher probability of csPCa detection in targeted samples (OR: 2.4 and 1.7, respectively; all p≤0.03). When the same analyses were repeated in those patients undergoing FB, operator expertise remained an independent predictor of csPCa (OR: 1.9; p=0.004). A progressive increase of the probability to detect csPCa with the increasing number of performed procedures was observed (Fig. 1)

Conclusions

We provided evidence that FB had higher detection rate of csPCa relative to CB. Moreover, operator expertise was significantly related to the detection of csPCa

Funding

none