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.

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.