經會陰超音波核磁共振影像融合切片合併經直腸超音波系統性切片於攝護腺癌之診斷:單一醫學中心之經驗

康庭碩、蔡佳穆、溫晨越、余家政、陳逸軒、郭威廷、林仁泰

高雄榮民總醫院 外科部 泌尿外科

Transperineal ultrasound magnetic resonance imaging fusion biopsy combined transrectal ultrasound systemic biopsy for prostate cancer detection – A single center experience

Ting-Shuo Kang, Chia-Mu Tsai, Chen-Yueh Wen, Chia-Cheng Yu, I-Hsuan Alan Chen, Wei-Ting Kuo, Jen-Tai Lin

Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

Purpose:

People are suspected to have prostate cancer usually based on elevated prostate-specific antigen (PSA) level, abnormal digital rectal examination, or abnormal transrectal ultrasound (TRUS). Transrectal ultrasonography-guided systemic biopsy is still the most commonly used for diagnosis at present time. However, the diagnostic rate of prostate cancer remained low and some people required diagnostic TURP or saturation biopsy. Multiparametric MRI (mpMRI) has excellent sensitivity for detecting suspicious lesions and target biopsy on lesions become feasible using fusion techniques. In this study, we reported our outcome of MR/US fusion-targeted biopsy combined with TRUS systemic biopsy for detecting prostate cancer.

Materials and methods:

We retrospectively reviewed the patients underwent MR/US fusion-targeted prostate biopsy from October 2019 to December 2020 in a single center. Patient with suspected prostate cancer detected by mpMRI (PI-RADS v2.0) were enrolled, regardless of previous TRUS biopsy. All patients received MR/US fusion-targeted biopsy combined with TRUS systemic biopsy. The diagnostic performance of targeted biopsy, systemic biopsy, and combination of both were assessed.

Results:

A total of 105 men underwent 3 Tesla mpMRI and fusion biopsy consecutively. The fusion biopsy was used to obtain targeted cores from the region of interest (ROI) (mean 10.8 biopsies) followed by a systemic biopsy (mean 12 biopsies). The mean overall number of biopsies taken was 22.8. Among the 105 men, 73 (69.5%) patients underwent first biopsy whereas 32 (30.5%) underwent repeated biopsy. The cancer detection rate was 25.7% and 21.0% by targeted biopsy and systemic biopsy respectively and combination of the two methods was 34.3%. 14 patients (13.3%) were detected by targeted biopsy only and 9 patients (8.6%) were detected by systemic biopsy only. Higher serum PSA and age were statistically significant predictors of prostate cancer detected by targeted biopsy, whereas PIRADS score and core number were insignificant. Targeted biopsy detected more intermediate to high risk cancer compared to systemic biopsy (18 vs 13 cases), and some low risk cancer (9 vs 9 cases). Among all patients, clinically significant prostate cancer was found in 92.6% of the positive targeted biopsies and 95.5% of the positive systemic biopsies. Three post-biopsy adverse events were reported without any infection cases (3 cases of acute urinary retention).

Conclusion:

For patients with suspicious lesion found in mpMRI, fusion-targeted biopsy combined TRUS systemic biopsy detected more prostate cancer than TRUS systemic biopsy only, especially intermediate or high risk cases.