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Comparison of free-hand transperineal mpMRI/TRUS fusion-guided biopsy with transperineal 12-core systematic biopsy for the diagnosis of prostate cancer: a single-center prospective study in China

  • Urology - Original Paper
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Abstract

Objectives

To prospectively compare biopsy outcomes between free-hand transperineal mpMRI/TRUS fusion targeted biopsy (TB) and transperineal systematic biopsy (SB) in patients with first prostate biopsy.

Patients and methods

In all, 224 consecutive patients with the suspicion of PCa were investigated. All patients were evaluated by 3.0-T mpMRI applying the ESUR criteria. All patients underwent free-hand transperineal mpMRI/TRUS fusion TB and additionally a transperineal SB. Pathological findings of TB, SB, and step-sectioned RP specimens were analyzed.

Results

The median age of the patients was 69 (40–85) years, median PSA level was 10.05 (3.61–78.39) ng/mL, and median prostate volume was 45.5 (22–77) mL. Overall, the PCa detection rate was 50.45% (113/224). TB detected significantly more cancer [44.2% (99/224) vs. 34.8% (78/224); P = 0.001] and clinically significant PCa [75.75% (75/99) vs. 62.82% (49/78); P = 0.005] than SB. For the upgrading of Gleason score, 39.74% (31/78), more clinically significant PCa was detected by using additional TB than by SB alone. Conversely, 5.05% (5/99) more clinically significant PCa was found by SB in addition to that by TB. The location of 96.67% (58/60) and Gleason score of 60% (36/60) of TB-proven ITs were correctly identified, as corroborated by RP specimens. The median IT volume was 1.125 (0.21–19.87) ml on MRI and 1.41 (0.13–9.56) ml in RP specimens.

Conclusions

Free-hand transperineal mpMRI/TRUS fusion biopsy was associated with a higher detection rate of clinically significant PCa while taking fewer cores. Moreover, this technique can reliably predict the location, and relatively reliably predict cancer volume and Gleason score of ITs.

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Abbreviations

DRE:

Digital rectal examination

mpMRI:

Multiparametric magnetic resonance imaging

PCa:

Prostate cancer

PI-RADS:

Prostate Imaging Reporting and Data System

PSA:

Prostate-specific antigen

SB:

Systematic biopsy

TB:

Targeted biopsy

TRUS:

Transrectal ultrasound

CDR:

Cancer detection rate

ITs:

Index tumors

ESUR:

European Society of Urogenital Radiology

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Acknowledgements

We thank all colleagues for their support during the data collection and the preparation of this manuscript.

Author’s contribution

QZ helped in project development and data analysis, and wrote the manuscript. WW was involved in project development and data collection, and wrote the manuscript. BZ was involved in project development and data analysis. JS wrote the manuscript. YF wrote the manuscript. DL wrote the manuscript. SG helped in data analysis and manuscript polishing. SZ was involved in data collection and wrote the manuscript. HH helped in data collection. XJ was involved in data collection. WZ contributed to data analysis and edited the manuscript. HG helped in project development and edited the manuscript.

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    Authors and Affiliations

    1. Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People’s Republic of China

      Qing Zhang, Wei Wang, Shengjie Zhang, Haifeng Huang & Hongqian Guo

    2. Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, People’s Republic of China

      Bing Zhang & Danyan Li

    3. Department of Pathology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, People’s Republic of China

      Jong Shi & Yao Fu

    4. Department of Urology, The Affiliated Yixing People’s Hospital of Jiangsu University, Yixing, 214200, Jiangsu, People’s Republic of China

      Xuping Jiang & Weimin Zhou

    5. School of Public Health, Nanjing Medical University, Nanjing, 210029, Jiangsu, People’s Republic of China

      Suhan Guo

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    1. Qing Zhang
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    Correspondence to Hongqian Guo.

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    Ethical standard

    All patients were counseled about the risks of the procedure, and then, they signed a consent form that included permission to use their clinical data for research. Institutional review board approval of Drum Tower Hospital, Medical School of Nanjing University, was obtained.

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    There is no conflict of interest.

    Additional information

    Qing Zhang and Wei Wang have contributed equally to the work.

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    Zhang, Q., Wang, W., Zhang, B. et al. Comparison of free-hand transperineal mpMRI/TRUS fusion-guided biopsy with transperineal 12-core systematic biopsy for the diagnosis of prostate cancer: a single-center prospective study in China. Int Urol Nephrol 49, 439–448 (2017). https://doi.org/10.1007/s11255-016-1484-8

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    • DOI: https://doi.org/10.1007/s11255-016-1484-8

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