Introduction

In a clinical setting, 12-core TRUS biopsy (12-TRUS-Bx) instead of sextant biopsy (6-TRUS-Bx) increases the low-grade (LG; Gleason 3+3) and high-grade (HG; Gleason >=3+4) prostate cancer (PCa) detection. MRI +/- target biopsy (TBx) detects less LG PCa and tends to detect more HG PCa, especially after previous negative biopsy. In this study we compare the performance of 6-TRUS-Bx vs 12-TRUS-Bx vs MRI +/- TBx in a pre-screened population-based cohort.

Methods

Men in the 5th screening round of the ERSPC Rotterdam (2013 – 2016) with PSA >=3.0 ng/ml received 6-TRUS-Bx or were included in the MRI side study. Men in the side study received MRI, blinded 12-TRUS-Bx and afterwards fusion target biopsy of PI-RADS >=3 lesions if present. The PCa detection rates of the 6-TRUS-Bx vs 12-TRUS-Bx vs MRI +/- TBx strategy were compared after stratification for previous biopsy.

Results

A total of 177 men received 6-TRUS-Bx; 158 men received MRI with 12-TRUS-Bx +/- TBx. Mean age and mean PSA were resp. 73.2 yrs (SD 1.1) and 5.1 ng/ml (SD 2.8). A total of 78/177 (44%) men who received 6-TRUS-Bx and 74/158 (47%) men who received 12-TRUS-Bx +/- TBx were biopsy naive. The rate of men with a non-suspicious MRI in the side study was 110/158 (70%)._x000D_ The HG PCa detection rates of 6-TRUS-Bx (17%), 12-TRUS-Bx (20%) and MRI +/- TBx (19%) in previously screened but biopsy naive men were comparable. The LG PCa detection rate in biopsy naive men of MRI +/- TBx (7%) was significantly lower as compared to 6-TRUS-Bx (23%) and 12-TRUS-Bx (34%). _x000D_ The HG PCa detection rates of 6-TRUS-Bx (5%), 12-TRUS-Bx (5%) and MRI +/- TBx (4%) in previously screened and biopsied (>=1 times) men were comparable. The LG PCa detection rate in previously biopsied men of 12-TRUS-Bx (24%) was significantly higher as compared to 6-TRUS-Bx (12%) and MRI +/- TBx (7%)._x000D_

Conclusions

In population-based screening with multiple visits the HG PCa detection rates of 6-TRUS-Bx, 12-TRUS-Bx and MRI +/- TBx are comparable, both in biopsy naive and previously biopsied men. Only 5% of previously biopsied men harbor HG PCa at repeat biopsy, confirming the need of better risk-stratification. An MRI +/- TBx screening strategy has the potential to reduce biopsy procedures (70%) and overdiagnosis of LG PCa.

Funding

none