Prospective comparison of transperineal magnetic resonance imaging/ultrasonography fusion biopsy and transrectal systematic biopsy in biopsy-naïve patients

Objectives To evaluate the value of multiparametric magnetic resonance imaging (mpMRI) for the detection of significant prostate cancer (PCa) and to compare transperineal MRI/ultrasound-fusion biopsy (fusPbx) to conventional transrectal systematic biopsy (sysPbx) in biopsy-naive patients. Patients and Methods This multicentre, prospective trial investigated biopsy-naive patients with suspicion of PCa undergoing transperineal fusPbx in combination with transrectal sysPbx (comPbx). The primary outcome was the detection of significant PCa defined as Gleason pattern four or five. Here, we present our analysis after a study period of two years. Results The study included 214 patients. Median number of targeted and systematic cores was six (range 2-15) and 12 (range 6-18), respectively. The overall PCa detection rate of comPbx was 52%. FusPbx detected more PCa than sysPbx (47% vs. 43%; p=0.15). The detection rate of significant PCa was 38% for fusPbx and 35% for sysPbx (p=0.296). The missing rate of significant PCa was 14% in fusPbx and 21% in sysPbx. ComPbx detected significantly more significant PCa than fusPbx and sysPbx alone (44% vs. 38% vs. 35%, p<0.005). Patients presenting PI-RADS 4 and 5 lesions showed a higher detection rate of significant PCa than patients presenting PI-RADS ≤3 lesions in comPbx (61% vs. 14%, p<0.005). Conclusions For biopsy-naive men with tumour-suspicious lesions in mpMRI, the combined approach outperformed both fusPbx and sysPbx in the detection of overall PCa and significant PCa. Thus, biopsy-naive patients may benefit from sysPbx in combination with mpMRI targeted fusPbx. This article is protected by copyright. All rights reserved.