Given the popularity of prostate specific antigen (PSA) testing in recent years, the number of patients undergoing diagnostic prostate biopsy has increased. The transrectal ultrasound-guided (TRUS) biopsy is considered as the gold standard for prostate cancer detection, although has a low sensitivity.
The current study aimed at enhancing prostate cancer diagnosis using MRI-TRUS fusion biopsy in patients with negative history of TRUS biopsy.
In the current study, patients undergone TRUS prostate biopsy with benign results that were candidates for repeat biopsy were recruited. After making the preparations, patients underwent magnetic resonance imaging (MRI)-TRUS fusion biopsy. Gleason score, the number of involved cores, perineural invasion, perilymphovascular invasion, and the percentage of core involvement were recorded.
Of the 191 patients, 70 (36.6%) had positive biopsies. The frequency of non-detectable cancers by targeted biopsy based on the level of cancer risk showed that at the very high-risk level, five (29.4%) and at high-risk level, two (11.7%) subjects were not recognized. The mean Gleason score in targeted (7.47±0.99) and random (7.13±1.04) positive biopsies showed a significant difference between the two groups (P = 0.045). Targeted biopsies are better than random ones to detect high-risk (33.9% vs 29.2%, P = 0.013 respectively) and very high-risk cancers (45.3% vs. 41.5%, P = 0.05 respectively).
The combination of both biopsy approaches is suggested to offer a reliable method with high rate of tumor detection.