Prostate cancer detection rate of multiparametric magnetic resonance imaging/transrectal ultrasound fusion prostate biopsy. Impact of clinical indications on biopsy outcome

Background & Aims. Multiparametric Magnetic Resonance Imaging has increased our ability to diagnose prostate cancer but questions remain about its proper use. Herein we evaluated potential differences between the clinically and multiparametric Magnetic Resonance Imaging-indicated and the non-clinically but multiparametric Magnetic Resonance Imaging-indicated fusion prostate biopsy. Methods. Outcomes of 99 fusion prostate biopsies (Group A) were compared with those of a matched population having undergone standard prostate biopsy (Group B). Results. The overall cancer detection rate was 60.6% in Group A and 29.2% in Group B (p < 0.001) whereas the rate of clinically-significant prostate cancer was 26.2% in Group A and 13.1% in Group B (p = 0.02). The cancer detection rate was 79.1% vs 13.1% for clinically-indicated and non clinically-indicated fusion biopsies, respectively; the clinically significant prostate cancer rate in these 2 populations were 45.6 and 0%, respectively. Cancer detection rate correlated with the Prostate Imaging-Reporting and Data System; in the setting of first biopsy, it was 84.6, 67.8%, and 100% for score 3, 4 and 5, respectively, whereas in the setting of repeat biopsy it was 28.5, 55.5% and 80% for score 3, 4 and 5, respectively. Complications rate was similar in both groups but all complications occurred in patients > 75y. Conclusions. Fusion prostate biopsy provided better cancer detection rate than standard prostate biopsy providing proper clinical indications. The misuse of multiparametric Magnetic Resonance Imaging in patients with no clinical indication for prostate biopsy led, particularly in the elderly, to an extremely high number of unnecessary biopsies with their inherent problems.