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. 2021 Nov;53(11):2251-2259.
doi: 10.1007/s11255-021-02989-2. Epub 2021 Sep 9.

Systematic biopsy should not be omitted in the era of combined magnetic resonance imaging/ultrasound fusion-guided biopsies of the prostate

Branimir Lodeta  1 , Vladimir Trkulja  2 , Georg Kolroser-Sarmiento  3 , Danijel Jozipovic  3 , Aigul Salmhofer  3 , Herbert Augustin  3
Affiliations

Systematic biopsy should not be omitted in the era of combined magnetic resonance imaging/ultrasound fusion-guided biopsies of the prostate

Branimir Lodeta et al. Int Urol Nephrol. 2021 Nov.

Abstract

Purpose: To evaluate prostate cancer detection rates with classical trans-rectal ultrasound-guided systematic 10-core biopsies (SB), targeted biopsies (TB) guided by magnetic resonance (MR)/US fusion imaging and their combination in biopsy-naïve and patients with previously negative prostate biopsies. We compared pathology results after radical prostatectomy with biopsy findings.

Methods: Consecutive patients with prostate imaging-reporting and data system lesions grade ≥ 3 submitted to MRI/US-guided TB and subsequent standard 10-core SB between December 2015 and June 2019 were analyzed.

Results: Detection rate (TB- or SB-positive) in 563 included patients (192 naïve, 371 with previous biopsies) was 56.7% (67.7% for the first, 50.9% for repeated biopsies). With TB (disregarding SB), the rates were 41.4%, 52.1% and 35.8%, respectively. With SB (disregarding TB), the rates were 49.1%, 63.0% and 41.8%, respectively. Eventually, 118 patients underwent surgery and clinically significant cancer was found in 111 (94.1%) specimens. Of those, 23 (20.7%) would have been missed had we relied upon a negative TB and 14 (12.6%) would have been missed had we relied upon a negative SB, disregarding a positive finding on the alternative biopsy template.

Conclusion: SB should not be omitted since TB and SB combination have higher detection rate of clinically relevant prostate cancer than either procedure alone.

Keywords: Fusion-guided prostate biopsy; Magnetic resonance imaging; Prostate cancer; Targeted prostate biopsy; Trans-rectal biopsy.

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