Multiparametric magnetic resonance imaging- transrectal ultrasound fusion targeted prostate biopsy with an elastic fusion platform: a prospective study in the Chinese population

Abstract

Objective: To compare multi-parametric magnetic resonance imaging (mpMRI) - transrectal ultrasound (TRUS) fusion targeted biopsy (TB) with systematic biopsy (SB) using an elastic fusion platform in a Chinese cohort. Patients and Methods: From July 2015 to August 2017, 232 Chinese men with elevated serum prostate-specific antigen (PSA) of 4-20 ng/mL underwent pre-biopsy mpMRI prostate. Those with suspicious lesion(s) underwent fusion biopsy (TB + 12-core SB) using the ArtemisÒ fusion system. The outcomes of TB and SB were compared. Results: A total of 304 mpMRI lesions were detected in 202 patients with mean age of 66.4 ± 6.4 and mean PSA of 9.1 ± 3.8 ng/mL, while no lesion was detected in 30 patients. A total of 916 targeted and 2424 systematic biopsy cores were taken, with overall core-wise cancer detection rate of 18.0% (165/916) vs 6.8% (164/2424) respectively (p<0.0001). TB detected more Gleason 7 cancers by proportion (55.2% vs 39.0%, p<0.0001) and yielded significantly longer mean cancer core length (8.5 ± 6.5 mm vs 2.8 ± 2.8 mm, p<0.0001). In patient-wise analysis, agreement between the two biopsy modalities was 67.8% (by Kappa statistics). TB alone would have avoided detection of 55.6% (10/18) of the clinically insignificant cancers compared with SB, at the expense of missing 10.3% (4/39) of the clinically significant cancers. Conclusion: mpMRI-US fusion targeted prostate biopsy is promising in improving the detection of clinically significant cancer in Chinese men with elevated PSA.