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Optimizing Biopsy Method Selection in Prostate Cancer: Role of DRE and MRI

Y. Lin¹, J. Li¹

¹Taichung Veterans General Hospital, Department of Urology, Taichung, Taiwan

Introduction:

Digital rectal examination (DRE), though limited in diagnostic accuracy, remains a conventional tool in prostate cancer screening. With the advent of multiparametric MRI, this study evaluated cancer detection rates across MRI-fusion, transperineal, and transrectal biopsies, stratified by DRE status. MRI-fusion biopsy outcomes were further analyzed by Prostate Imaging–Reporting and Data System (PIRADS) scores to clarify the role of DRE and inform optimal biopsy strategies.

Material and methods:

This retrospective cohort study was conducted at Taichung Veterans General Hospital in Taiwan. A total of 853 patients undergoing prostate biopsy were enrolled, categorized into two groups based on DRE results: DRE-positive (n = 434) and DRE-negative (n = 419). Demographic and clinical characteristics including age, prostate-specific antigen (PSA) levels, prostate volume, and PSA density were compared between the two groups. Cancer detection rates among biopsy methods (MRI-guided, transperineal, and transrectal biopsies) were statistically analyzed, with further subgroup analysis according to PIRADs scores (III–V) in the DRE-negative cohort receiving MRI-guided biopsies.

Results:

Patients in the DRE-positive group were significantly older, higher PSA levels, smaller prostate volumes, and higher PSA density compared to the DRE-negative group(Table1).Prostate cancer detection rates were significantly higher in patients with positive DRE findings (69.6% vs. 43.4%, p < 0.001) In the DRE-positive cohort, biopsy method significantly impacted detection rates (p = 0.020), with post-hoc analyses (Bonferroni adjusted α = 0.0167) showing a significantly higher detection rate with transperineal biopsy compared to MRI-fusion biopsy (74.7% vs. 54.8%, p = 0.0145); however, there was no significant difference between MRI-guided and transrectal biopsies or between transperineal and transrectal biopsies. No statistically significant differences were observed among biopsy methods in the DRE-negative cohort (p = 0.131)(Figure1). Further analysis of MRI-fusion biopsy results in DRE-negative patients revealed detection rates of 18.75% (PIRADs III), 39.22% (PIRADs IV), and 72.73% (PIRADs V). Compared with the overall detection rate across all biopsy methods (43.44%), PIRADs V patients showed a significantly higher detection rate (p = 0.031), while PIRADs III (p = 0.252) and IV (p = 0.638) showed no significant difference(Figure2).