蔡仕傑¹、黃逸修^{1, 3, 4}、王信凱²、沈書慧²、魏子鈞^{1, 3, 4}、黃奕燊^{1, 3, 4}、

林志杰^{1, 3, 4}、林子平^{1, 3, 4}、鍾孝仁^{1, 3, 4}、張延驊^{1, 3, 4}、黃志賢^{1, 3, 4}

¹臺北榮民總醫院泌尿部，²放射線部；³國立陽明大學醫學系泌尿學科；⁴書田泌尿科學研究中心

Shi-Jie Tsai¹, Eric Yi-Hsiu Huang^{1, 3, 4}, Hsin-Kai Wang², Shu-Huei Shen²,

Tzu-Chun Wei^{1, 3, 4}, I-shen Huang^{1, 3, 4}, Chih-Chieh Lin^{1, 3, 4}, Tzu-Ping Lin^{1, 3, 4},

Hsiao-Jen Chung^{1, 3, 4}, Yen-Hwa Chang^{1, 3, 4}, William J.S. Huang^{1, 3, 4}

¹ Department of Urology, and ²Department of Radiology, Taipei Veterans General Hospital, Taiwan

³Department of Urology, School of Medicine, and ⁴Shu-Tien Urological Science Research Center, National Yang-Ming University, Taipei, Taiwan

 

The transrectal ultrasound-guided (TRUS) prostate biopsy has been the gold standard for prostate cancer detection. However, its lack of accuracy had led to underdiagnoses of prostate cancer and multiple biopsies for many patients. Favorable results have been reported about targeted prostate biopsies using magnetic resonance (MR)/ultrasound (US) fusion platforms recently. We aimed to evaluate the performance of MR/US fusion-targeted prostate biopsy in patients with previous negative biopsies in our institute.

We retrospectively reviewed the patients underwent MR/US fusion-targeted prostate biopsy form January 2016 to December 2019. Patients with previous negative prostate biopsies with suspicious prostate lesion detected by multiparametric MR imaging were enrolled. The location of the lesions and Prostate Imaging Reporting and Data System version 2(PI-RADS v2) score were evaluated by a dedicated radiologist and the MR/US fusion-targeted biopsy was performed by another radiologist. The numbers of previous negative biopsies, patient and lesion characteristics were compared between cancer and non-cancerous patients. The diagnostic performance of targeted biopsy, systemic biopsy, and combination of both were also assessed.

A total of 139 patients with suspicious cancerous lesion on pre-biopsy multiparametric MR imaging were included. Among them, 136 patients underwent concurrent targeted biopsy and systemic biopsy. Cancer was diagnosed in 67(48.2%) and 58(42.6%) by targeted biopsy and systemic biopsy, respectively. The cancer detection rate of combination of the two methods was 53.2%. 16 patients (11.5 %) were detected by targeted biopsy only and 8 patients (5.8 %) were detected by systemic biopsy only. The numbers of previous negative biopsy were not predictive of cancerous lesion detected by targeted biopsy. Higher serum prostate-specific antigen(PSA), PSA density, age, PIRADS score, and anterior prostate lesion were statistically significant predictors of prostate cancer detection by targeted biopsy. Among patients received concurrent targeted and systemic biopsy, targeted biopsy was more likely to detect clinically significant prostate cancer (ISUP grade group ≥2) when compared with systemic biopsy (34.6% vs. 23.5%, p<0.001).

For patients with suspicious lesion detected by pre-biopsy MR imaging, MR/US fusion-targeted prostate biopsy can improve the detection rate of prostate cancer as well as the detection of clinically significant prostate cancer in the repeated biopsy setting.