Presentation Authors: Michael Stencel*, James Kelley, Sharon Hill, Nathan Hale, Samuel Deem, Charleston, WV
Introduction: Trans-rectal ultrasound-guided biopsy (TRUS-Bx) has been the traditional standard for diagnosing prostate cancer. However, its potential infectious complications and relatively low cancer detection have fostered development of new approaches and techniques. Patients with prior negative biopsy and persistently elevated PSA pose a management dilemma, and often undergo repeat trans-rectal biopsies. Magnetic resonance-ultrasound (MRI-US) fusion biopsy and trans-perineal systematic biopsy have shown improved cancer detection rates, yet these modalities have not been directly compared.
Methods: After obtaining institutional review board approval, retrospective review was performed on patients with prior negative TRUS-Bx that had continued clinical suspicion for prostate cancer due to elevated PSA. Systematic trans-perineal prostate biopsy (TP-Bx) and MRI-US fusion guided prostate biopsy (MRI-Bx) were directly compared, with detection of clinically significant prostate cancer being the primary endpoint, and overall cancer detection as a secondary outcome.
Results: 51 patients in total were reviewed, with 23 undergoing MRI-Bx and 28 with TP-Bx. Mean patient age was 68 v. 66 years (MRI-Bx v. TP-Bx) and median PSA 10 v. 7.1 ng/dL (MRI-Bx v. TP-Bx). Mean prostate volume was 72.8 v. 54.3 (MRI-Bx v. TP-Bx). Age, PSA, and prostate volume were not significantly different between the two groups. Mean number of cores sampled from the region of interest in the MRI-Bx were 5, and 23.7 cores in the systematic TP-Bx. When comparing MRI-Bx directly with TP-Bx, overall prostate cancer detection rates were 73.9% v. 42.8%, respectively (p < 0.05). Clinically significant prostate cancer (Gleason score â‰¥ 7) was detected at a rate of 60.9% in the MRI-Bx and 21.4% in TP-Bx groups (p < 0.05).
Conclusions: When comparing MRI-US fusion biopsy to trans-perineal biopsy in patient with previous negative prostate biopsy, MRI-US fusion appears superior in detection of both clinically significant and overall prostate cancer. Despite its lower cancer detection rates in this setting, trans-perineal biopsy may still offer a reasonable option for those with negative MRI or contraindication for MRI.