Abstract: PD43-01
Sources of Funding: none

Introduction

Multiparametric magnet resonance imaging (mpMRI) plays an important role in the diagnostic of prostate cancer (PCa). However, systematic prostate biopsy (sysPbx) is still the reference method for diagnosing PCa in first and repeat biopsy setting. We compared MRI/ultrasound-fusion biopsy (fusPbx) to sysPbx in patients with and without prior biopsy.

Methods

1060 consecutive patients with suspicion of PCa were investigated (first biopsy: n=222, repeat biopsy: n=838). All patients were examined by mpMRI applying the criteria of the European Society of Urogenital Radiology. Lesions were classified according PI-RADS. All patients underwent a transperineal fusPbx (mean 4 cores/lesion) and, additionally, a transrectal sysPbx (mean 12 cores) during the same session.

Results

In patients undergoing repeat biopsy (n=838), PCa detection rate was 51% (n=426) (GS≥7(3+4): 39% (n=325)). In fusPbx, PCa detection rate was 41% (n=345) compared to 34% (n=288) in sysPbx (p<0.0001). Also here, fusPbx showed a higher detection rate of GS ≥7(3+4) than sysPbx (33% (n=276) vs. 26% (n=214), p<0.0001). In repeat biopsy, sysPbx alone would have missed 35% (115/325) of GS ≥7(3+4) and fusPbx alone would have missed 17% (54/325) of GS ≥7 (3+4)._x000D_ In first biopsy setting (n=222), PCa detection rate was 53% (n=118) (GS ≥7(3+4): 44% (n=98)). FusPbx detected more PCa than sysPbx (49% (n=108) vs. 40% (n=89); p=0.003). Furthermore, fusPbx showed a higher detection rate of GS ≥7(3+4) than sysPbx (38% (n=85) vs. 33% (n=74), p=0.099). Missing rate of GS ≥7 (3+4) tumours was 24% (24/98) in sysPbx and 13% (13/98) in fusPbx._x000D_

Conclusions

Especially patients undergoing repeat biopsy benefit of fusPbx due to a significant higher detection rate of GS≥7 tumours. In patients without prior biopsy, the combination of both biopsy modalities was associated with a higher detection rate of GS≥7 tumours. However in both groups, a relatively high portion of additional GS≥7 tumours was detected by sysPbx alone. Therefore, the combination of both biopsy modalities should be still performed in patients with repeat biopsy and should be offered in first biopsy setting.

Funding

none