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. 2022 Mar;10(1):45-49.
doi: 10.1016/j.prnil.2021.10.002. Epub 2021 Nov 4.

The value of magnetic resonance imaging and ultrasonography (MRI/US)-fusion biopsy in clinically significant prostate cancer detection in patients with biopsy-naïve men according to PSA levels: A propensity score matching analysis

Hye J Byun  1 , Teak J Shin  1 , Wonho Jung  1 , Ji Y Ha  1 , Byung H Kim  1 , Young H Kim  2
Affiliations

The value of magnetic resonance imaging and ultrasonography (MRI/US)-fusion biopsy in clinically significant prostate cancer detection in patients with biopsy-naïve men according to PSA levels: A propensity score matching analysis

Hye J Byun et al. Prostate Int. 2022 Mar.

Abstract

Objectives: To evaluate the detection rate of clinically significant prostate cancer (csPCa) in Magnetic resonance imaging and ultrasonography (MRI/US) fusion biopsy in patients with biopsy-naïve men for varying prostate-specific antigen (PSA) levels. Since MRI can efficiently detect csPCa compared to standard transrectal ultrasound (TRUS) guided biopsy; however, the optimal PSA threshold for its use is unclear.

Materials and methods: We retrospectively reviewed those who underwent MRI/US-fusion and standard biopsy from January 2016 to June 2018. Patients were divided into three groups: PSA <4, 4-10, >10 ng/mL. Propensity scoring was performed to balance the characteristics of the different biopsy groups, and the detection rate of csPCa was compared.

Results: Data from a total of 670 males were included in the analysis (standard TRUS, n = 333; MRI/US fusion, n = 337). Prior to matching, patients who received MRI/US-fusion biopsy had lower prostate volume. Propensity score matching balanced this characteristic and generated a cohort comprising 195 patients from each group. In the matched cohort, patients with PSA 4-10 ng/mL had a significantly increased risk of csPCa by MRI/US-fusion vs. standard biopsy (35.0% vs. 26.6%, P = 0.033). However, patients with PSA <4 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (12.0% vs. 16.0%, P = 0.342), whereas, patients with PSA >10 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (78.0% vs. 80.0%, P = 0.596). In multivariate logistic analysis among patients with PSA 4-10 ng/mL, MRI/US-fusion biopsy (odds ratio: 2.46, 95% confidence interval = 1.31-4.60, P = 0.005) were significantly associated with a detection of csPCa.

Conclusions: Detection of csPCa by MRI/US-fusion biopsy is more efficient in patients with biopsy-naïve men with PSA 4-10 ng/mL. However, standard TRUS biopsy may identify csPCa in patients with PSA <4 ng/mL and ≥10 ng/mL, emphasizing the importance of performing a standard biopsy in conjunction with MRI/US-fusion biopsy in such populations.

Keywords: Magnetic resonance imaging; Prostate cancer; Prostate-specific antigen.

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Conflict of interest statement

There is no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of inclusion criteria of the final patient cohort.
Fig. 2
Fig. 2
Incidence of clinically significant prostate cancer between standard TRUS-guided biopsy and MRI/US-fusion biopsy according to PSA thresholds, PSA, prostate-specific antigen; TRUS, transrectal ultrasound; MRI, magnetic resonance image; PCa, prostate cancer; csPCa, clinically significant prostate cancer.
See this image and copyright information in PMC

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