Saturation target biopsy can overcome the learning curve of magnetic resonance imaging/ultrasound fusion biopsy of the prostate

Background: Magnetic resonance imaging (MRI) has emerged as a promising tool for diagnosing prostate cancer. Magnetic resonance imaging/ultrasound (MRI/US) fusion target biopsy (TB) can increase the detection rate of clinically significant prostate cancer (csPC) and decrease the detection rate of clinically insignificant PC (ciPC) compared with systematic biopsy (SB). However, the MRI/US fusion biopsy had a steep learning curve. A new biopsy template, saturation TB (sTB), was reported to provide a cancer detection rate comparable to that of the combination of TB and SB. This study reports our experience with MRI/US fusion prostate biopsy and investigates the role of sTB in MRI/US fusion biopsy. Methods: We prospectively enrolled males with elevated prostate-specific antigen or abnormal digital rectal examination (DRE) and Prostate Imaging Reporting & Data System (PI-RADS) score $\ge$3 who underwent MRI/US fusion prostate biopsy in a tertiary referral center. We compared cancer detection rates among different biopsy templates, including TB, SB, sTB, and the combination of TB and SB. The biopsy results and complications were recorded. Results: The detection rate of csPC by sTB was significantly higher than that of TB (53% vs. 44%; p = 0.008) or SB (53% vs. 43%; p = 0.002). The median biopsy cores were 6, 15, and 26 for TB, sTB, and the combination of TB and SB, respectively. In other words, sTB could decrease 11 biopsy cores without compromising the cancer detection rate compared with the combination of TB and SB. There were no Clavien-Dindo score of ≥3 complications in any of the patients. Conclusion: The sTB template can overcome targeting errors during MRI/US fusion biopsy, offering a cancer detection rate equal to the combination of TB and SB with reduced biopsy cores.

Learning curve; Magnetic resonance imaging (MRI); MRI-ultrasound fusion; Prostate cancer; Target biopsy

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