Prostate cancer detection using magnetic resonance imaging-transrectal ultrasound fusion biopsy: A retrospective cohort study

Introduction: Transrectal ultrasound (TRUS) guided systematic prostate biopsy is conventionally used for the diagnosis of carcinoma prostate (CaP). However, magnetic resonance imaging (MRI) guided biopsies have been shown to have superior diagnostic performance. MRI-TRUS fusion biopsy improves the detection by combining the systematic and the targeted biopsies (TB). In this study, we evaluated the role of fusion biopsy in the detection of CaP as well as clinically significant carcinoma prostate (CsCaP). Methods: In this retrospective study, the patients who underwent fusion biopsy from January 2016 to July 2022 were evaluated. Patients underwent multiparametric MRI and the suspicious lesions were reported as per the Prostate Imaging Reporting and Data System (PIRADS) version 2. The clinical, imaging, and biopsy parameters were recorded and evaluated. Results: A total of 330 patients with PIRADS >= 3 underwent MRI-TRUS fusion biopsy and prostate cancer was detected in 187 patients (56.67%). With an increase in the PIRADS score, there was a significant rise in the detection of CaP (P < 0.001) and CsCaP (P < 0.0000001). Prostatitis was observed in 13%-18.1% of the patients with a lesion on MRI irrespective of the PIRADS score. The systematic and TB were comparable for the detection of CaP (P = 0.88) and CsCaP (P = 0.26). With a prostate-specific antigen density (PSAD) cutoff of 0.15 ng/mL/cc and 0.22 ng/mL/cc, biopsy could be safely avoided in 14.2% and 20.3% of the patients, missing only 0.3% of CaP and 0.9% of CsCaP, respectively. Different subgroups based on PSA levels, prostate volume, lesion dimension, and PIRADS score did not show a significant difference between the systematic and the targeted cores for the detection of CsCaP. Conclusion: This single center study of MRI-TRUS fusion prostate biopsy shows that in men with clinical suspicion of prostate cancer a pre-biopsy MRI and MRI-TRUS fusion combined systematic and targeted prostate biopsy improves the detection of prostate cancer and CsCaP. Patients with a PIRADS 3 lesion with a PSA density <0.22 can safely avoid prostate biopsy, without a significant risk of missing clinically significant prostate cancer.