[Comparison of systematic, targeted and combined prostate biopsies for the diagnosis of prostate cancer with MRI lesion]

Abstract

Objective: The objective of our study is to compare the performance of systematic, targeted and combined biopsies in the same cohort for the detection of clinically significant prostate cancer (csCaP).

Material and method: We included patients coming for first series of prostate biopsies, from January 2016 to May 2020, with at least one PI-RADS lesion ≥3 on MRI. All patients underwent 12 systematic biopsies, combined with at least 2 biopsies per target lesion, using the MRI/3D ultrasound fusion system Urostation® (Koelis).

Results: We included 234 patients. Combined biopsies allowed a better detection rate of csCaP (59.4%) compared to systematic biopsies (55.6%, P=0.01) and targeted biopsies alone (44.4%, P<0.001). The same is true for the overall prostate cancer (CaP) rate: 65.4% for the combined biopsies versus 61.1% for the systematic biopsies (P=0.002) and 49.1% for the targeted biopsies (P<0.001). The detection rates of clinically non-significant prostate cancer (ncsCaP) were similar (6% vs. 5.6% vs. 4.7% for combined, systematic and targeted biopsies respectively). Targeted biopsies found 10 (4.3%) CaP undiagnosed by systematic biopsies including 6 (2.6%) csCaP, and an upgraded ISUP score for 17 (7.3%) patients. Systematic biopsies found 38 (16.2%) CaP undiagnosed by targeted biopsies including 33 (14.1%) csCaP, and allowed an upgraded ISUP score for 19 (8.1%) patients.

Conclusion: Combined biopsies provide the best detection rate for csCaP in our study.

Keywords: Biopsie ciblée; Biopsie prostatique; Cancer de prostate; Fusion échographie-IRM; IRM; MRI; MRI-TRUS fusion; Prostate biopsy; Prostate cancer; Targeted Biopsy.