Value of cognitive fusion targeted and standard systematic transrectal prostate biopsy for prostate cancer diagnosis

Abstract

The aim of this study was to compare the accuracies of cognitive fusion-guided targeted biopsy (TB), systematic biopsy (SB), and combined TB+SB for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in males with lesions detected by magnetic resonance imaging (MRI). We conducted a retrospective analysis of individuals who underwent prostate biopsy at Peking University People's Hospital (Beijing, China), with an emphasis on patients with both transrectal TB and SB. The main objective was to determine the precisions of SB, TB, and TB+SB for diagnosing PCa and csPCa. We also evaluated the detection rates of TB, SB, TB+ipsilateral-SB (ipsi-SB), TB+contralateral-SB (contra-SB), and TB+SB for PCa and csPCa in patients with unilateral MRI lesions. We compared the diagnostic yields of the various biopsy schemes using the McNemar's test. A total of 180 patients were enrolled. The rates of PCa detection using TB, SB, and TB+SB were 52.8%, 62.2%, and 66.7%, respectively, and the corresponding rates for csPCa were 46.1%, 56.7%, and 58.3%, respectively. Among patients with unilateral MRI lesions, the PCa detection rates for TB, SB, TB+ipsi-SB, TB+contra-SB, and TB+SB were 53.3%, 64.8%, 65.6%, 61.5%, and 68.0%, respectively. TB+ipsi-SB detected 96.4% of PCa and 95.9% of csPCa cases. These findings suggest that the combination of TB+SB has better diagnostic accuracy compared with SB or TB alone. For patients with unilateral MRI lesions, the combination of TB+ipsi-SB may be suitable in clinical settings.

Figure 1

The flow diagram demonstrating inclusion and exclusion criteria to derive final study cohort. SB: systematic biopsy; mpMRI: multiparametric magnetic resonance imaging; PI-RADS: Prostate Imaging-Reporting and Data System.

Figure 2

Subgroup analyses based on PI-RADS score, PSA level, and prostate volume. (a) PCa detection rate and (b) clinically significant PCa detection rate according to PI-RADS score. (c) PCa detection rate and (d) clinically significant PCa detection rate according to PSA level. (e) PCa detection rate and (f) clinically significant PCa detection rate according to prostate volume. ^*P<0.05. PCa: prostate cancer; csPCa: clinically significant prostate cancer; TB: targeted biopsy; SB: systematic biopsy; PI-RADS: Prostate Imaging-Reporting and Data System; PSA: prostate-specific antigen; PV: prostate volume.