There exists a growing debate as to whether multiparametric MRI (mpMRI) with fusion transrectal ultrasound (TRUS) guided prostate biopsy (PBx) alone without standard template is sufficient for evaluation of patients with suspected prostate cancer (PCa). Our objective was to describe our experience with fusion targeted PBx and assess whether it could obviate the need for concomitant standard 12-core template PBx.

We retrospectively reviewed our prospectively collected database of patients undergoing fusion TRUS-guided PBx. All images and lesions were graded according to the Prostate Imaging Reporting and Data System version 2 . All patients underwent targeted biopsy followed by standard 12-core double sextant biopsy within the same session. Clinically significant PCa (csPCa) was defined as grade group ≥ 2 PCa.

A total of 506 patients were included. Indications were elevated PSA with a previous negative PBx (46%), PCa on active surveillance (35%), elevated PSA without a prior PBx (15%), and isolated abnormal digital rectal exam (3%). Overall cancer detection rate was 57.7% vs. 54.0% (p=0.12) and csPCa detection rate was 24.7% vs. 30.8% (p=0.001) for standard vs. fusion PBx, respectively. Of 185 patients diagnosed with csPCa, 29 (16%) would have been missed if only the targeted fusion PBx was performed.

Fusion targeted PBx is associated with a higher detection rate of csPCa compared to standard double sextant biopsy; however, standard double sextant biopsy should still be performed as part of routine fusion targeted PBx procedure to avoid missing a significant proportion of csPCa.

The Journal of urology. 2019 May 30 [Epub ahead of print]

Nawar Hanna, Matthew F Wszolek, Amirkasra Mojtahed, Edouard Nicaise, Bo Wu, Francisco J Gelpi-Hammerschmidt, Keyan Salari, Douglas M Dahl, Michael L Blute, Mukesh Harisinghani, Adam S Feldman

Massachusetts General Hospital, Department of Urology , Boston , MA , USA., Massachusetts General Hospital, Department of Radiology , Boston , MA , USA.