Diagnostic Accuracy and Value of Magnetic Resonance Imaging-Ultrasound Fusion Transperineal Targeted and Template Systematic Prostate Biopsy Based on Bi-parametric Magnetic Resonance Imaging

Original Article Purpose The purpose of this study was to investigate the diagnostic value of magnetic resonance imaging (MRI)-ultrasound (US) fusion transperineal targeted biopsy (FTB) and fusion template systematic biopsy (FSB) for prostate cancer (PCA) and clinically significant prostate cancer (csPCA) (intermediate/high grade [Gleason score ! 3+4]) based on bi-parametric MRI (bpMRI). Materials and Methods Retrospectively, we analyzed 300 patients with elevated prostate-specific antigen (! 4.0 ng/mL) and/or abnormal findings in a digital rectal examination at the Korea University Hospital. All 300 men underwent bpMRI-US fusion transperineal FTB and FSB in the period from April 2017 to March 2019. Results PCAs were detected in 158 of 300 men (52.7%), and the prevalence of csPCA was 34.0%. CsPCAs were detected in 12 of 102 (11.8%) with Prostate Imaging-Reporting and Data System (PI-RADS) 3, 42 of 92 (45.7%) with PI-RADS 4, respectively; and 45 of 62 (72.6%) men with PI-RADS 5, respectively. BpMRI showed a sensitivity of 95.1% and negative predictive value of 89.6% for csPCA. FTB detected additional csPCA in 33 men (12.9%) compared to FSB. Compared to FTB, FSB detected additional csPCA in 10 men (3.9%). Conclusion BpMRI-US FTB and FSB improved detection of PCA and csPCA. The accuracy of bi-parametric MRI is comparable with that of multi-parametric MRI. Further, it is rapid, simpler, cheaper, and no side effects of contrast media. Therefore, it is expected that bpMRI-US transperineal FTB and FSB could be a good alternative to conventional US-guided transrectal biopsy, which is the current gold standard.