2D-US versus 3D-US guided saturation biopsy to detect prostate cancer
INTRODUCTION AND OBJECTIVES: Grey scale (GS) two dimension (2D) transrectal ultrasound- (TRUS-) guided systematic prostate biopsy is the clinical standard for prostate cancer diagnosis. In the last years, the GS three dimension (3D) TRUS-guided sampling has been introduced as a new technique that improves prostate mapping as well as clinical quality management. We compared detection rate of 2D-US versus 3D-US guided saturation biopsy in two groups of patients at their initial biopsy.
METHODS: From December 2012 to October 2014 we prospectively analyzed data of 84 consecutive patients with no previous history of prostate cancer who underwent an initial prostate biopsy due to an abnormal PSA and/or DRE, using respectively 2D-US and 3D-US guided system. All biopsies were done by a single experienced operator using the same
standardized protocol of transrectal random systematic saturation biopsy. All 3D procedures were performed using an end firing, 3D TRUS probe and a Sonoace X8 ultrasound machine (with Koelis Urostation) capable of 3D image acquisition allowing real-time 3D TRUS registration system to spatially map each biopsy needle trajectory (Organ Based Tracking).
RESULTS: The two groups were comparable for age, total PSA, DRE and prostate volume. Cancer detection rate was high in both groups but significantly higher in the group of 3D-US guided biopsy, 50% vs 45% respectively (p=0.001)[Table 1]. A between group comparison highlighted a statistically significant difference in detecting higher rate of cores involved and clinically relevant prostate cancer using the 3D-US system (p=0.004 and p=0.002, respectively) [Table 2].
CONCLUSIONS: This experience showed the superiority of 3D-US guided biopsy in detecting prostate cancers that would have been missed using the 2D-US guided saturation protocol.