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

  • Urology - Original Paper
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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.

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Availability of data and materials (data transparency)

The data that support the findings of this study are available on request from the corresponding author, BL.

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Acknowledgements

We thank Dr. Herwig Scharfegger and Dr. Isabel Igerc for performing re-evaluation of all MR images according to PI-RADS v2.

Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Urology and Andrology, Klinikum Klagenfurt, Feschnigstrasse 11, 9020, Klagenfurt, Austria

    Branimir Lodeta, Georg Kolroser-Sarmiento, Danijel Jozipovic, Aigul Salmhofer & Herbert Augustin

  2. Department of Pharmacology, Zagreb University School of Medicine, Zagreb, Croatia

    Vladimir Trkulja

Authors
  1. Branimir Lodeta
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  2. Vladimir Trkulja
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  3. Georg Kolroser-Sarmiento
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  4. Danijel Jozipovic
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  5. Aigul Salmhofer
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  6. Herbert Augustin
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Contributions

BL: Project development, Data Collection, Manuscript writing. VT: Data analysis, Manuscript editing. GKS: Protocol development, Data Collection. DJ, AS: Data Collection. HA: Manuscript writing/editing.

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Correspondence to Branimir Lodeta.

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Lodeta, B., Trkulja, V., Kolroser-Sarmiento, G. et al. Systematic biopsy should not be omitted in the era of combined magnetic resonance imaging/ultrasound fusion-guided biopsies of the prostate. Int Urol Nephrol 53, 2251–2259 (2021). https://doi.org/10.1007/s11255-021-02989-2

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