3D US versus US/MRI fusion-guided target biopsy to detect prostate cancer: a preliminary experience
INTRODUCTION AND OBJECTIVES: Recent developments in US systems and imaging modalities such as multiparametric MRI have led to a promising advance in mapping and correctly tracking target regions. We compared detection rate of 3D US versus US/MRI fusion-guided prostate biopsy in two groups of patients at their initial biopsy.
METHODS: From December 2013 to October 2014 we prospectively analyzed data of 51 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 3D-US and 3D-US/MRI fusion guided system. All the biopsies were done by a single experienced operator using the same standardized protocol of transrectal random systematic saturation biopsy and three target cores of each suspicious area in the US/MRI fusion-guided biopsy group. All procedures were performed using Urostation (Koelis, Grenoble, France).
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 for US/MRI fusion guided biopsy 74.2% vs 50% (p=0.006)[Table 1]. A between group comparison high-lighted a statistically significant and a trend towards significance in detecting clinically nonsignificant and clinically significant prostate cancer (p=0.005 and p=0.08, respectively) [Table2]. In a post-hoc analysis performed on patients with a positive fusion biopsy, prostate cancer detection rate of systematic cores and target cores were 78.2 % (18/23) and 91.3% (21/23), respectively (p=0.001).
CONCLUSIONS: This preliminary experience showed a reasonable evidence demonstrating the superiority of the 3D US/MRI fusion guided biopsies in detecting prostate cancers that would have been missed using the 3D saturation protocol.