Ricerc@Sapienza

BACKGROUND: Transrectal ultrasound-guided biopsy (TRUS-Bx) is recommended by the European Urology Association (EAU) as the first diagnostic modality for men at risk of prostate cancer (PCa). Current EAU guidelines reserve the use of multiparametric MRI to target or guide any repeat biopsy (mpMRI-Bx). It remains uncertain if TRUS-Bx is effective as a first strategy in terms of costs, diagnostic performance, time to diagnosis, and triage for individualised therapy.

PURPOSE: The aim of this study was to validate the role of MR/Ultrasound Fusion-Guided Targeted Biopsy as a first diagnostic modality in subjects with clinical suspicion of prostate cancer (PCa). MATERIALS AND METHODS: 108 men (age range 46-78 years) with clinical suspicion for PCa (PSA > 4 ng/mL) underwent multiparametric MRI of the prostate (mpMRI) and, when suspicious lesion were found (according to the PIRADSv2 scoring system), targeted biopsy was performed. All patients without significant alteration patterns at mpMRI have been referred for follow-up at 1 year.

The aim of this study was to evaluate the performance of multiparametric magnetic resonance imaging (mpMRI)-ultrasound (US) fusion-targeted biopsies (TB) in men with primary and repeated biopsies comparing the cancer detection rate (CDR) of random biopsies (RB) + TB versus only TB.

In the Prostate Imaging Reporting and Data System (PI-RADS) 3 population, the overall detection rates for prostate cancer (PC) and clinically significant PC (csPC) range from 10.3% to 55.8% and from 3.4% to 46.5%, respectively. Decision to perform only a targeted biopsy or a systematic biopsy should be associated with a lower detection rate of both PC and csPC. PI-RADS v1 or v2 seems to have no significant impact on biopsy outcomes. A prostate-specific antigen density of ≥0.15 ng/ml/ml may represent an index to decide whether to biopsy or not.