The use of MRI/ultrasound fusion biopsy in the diagnosis of clinically significant prostate cancer

Introduction. Standard prostate biopsy with subsequent histological verification is now an integral part of the diagnosis of prostate cancer (PC); however, the number of false-negative results and cases of underestimation of the degree of tumor aggressiveness remain excessively high. The active and massive clinical introduction of multiparametric magnetic resonance imaging (mpMRI) in combination with hybrid technologies, such as MRI/ultrasound fusion biopsy, can significantly increase the detection rate of moderate- and high-risk cancers.

Materials and methods. This investigation covered 33 patients with suspected PC that was detected in 69.7 % of the patients.

Results. The comparative histological results from targeted and standard prostate biopsies showed the detection rate of clinically significant cancer (a total Gleason score of ≥7), which was equal to 86.7 and 66.7 %, respectively. The results of targeted biopsy were statistically significantly (correlation coefficient r = 0.8; p <0.0001) similar to those of standard biopsy in terms of the degree of identifying nodules with the highest malignancy potential; at the same time a regression analysis revealed that the accuracy of high-risk cancer detection in the target biopsy was higher than that of standard biopsy (p <0.0001). Thus, MRI/ultrasound fusion-targeted biopsy demonstrated a lower sensitivity in detecting clinically insignificant PC than standard biopsy. Data of mpMRT with grading in accordance with the Prostate Imaging Reporting and Data System (PI-RADSv2) showed a statistically significant correlation with the results of the targeted biopsy (correlation coefficient r = 0.7; p <0.02). 

Conclusion. The further vector of development of prostate biopsy will most likely be reduced to the concept of targeted, or “sighted”, biopsy, which in turn can significantly increase the detection rate of clinically significant forms of PC, rightly define the clinical stage of the disease, and correctly stratify risks.