Accuracy of magnetic resonance imaging/ultrasound fusion targeted biopsies to diagnose clinically significant prostate cancer in enlarged compared to smaller prostates

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De Gorski A., Rouprêt M., Peyronnet B., Le Cossec C., Granger B., Comperat E., Cussenot O., Renard-Penna R., Mozer P.

Journal of Urology 2015 194:3 (669-673)

Purpose We assessed the accuracy of magnetic resonance imaging/transrectal ultrasound fusion biopsies to diagnose prostate cancer according to gland size. Materials and Methods A prospective study was performed in 232 men with a first round biopsy, multiparametric magnetic resonance imaging with a lesion, a Likert score of 2 or greater and prostate specific antigen less than 10 ng/ml. All men underwent a standard 12-core protocol plus a protocol of 2 or 3 targeted cores. Significant prostate cancer was defined as at least 1 core with a Gleason score of 7 (3 + 4) or 6 with a greater than 4 mm maximal cancer core length. Results Mean ± SD patient age was 64 ± 6.4 years, mean prostate specific antigen was 6.65 ± 1.8 ng/ml and mean prostate volume was 40 ± 24.3 ml. The overall detection rate of clinically significant prostate cancer was 44%. The detection rate of clinically significant prostate cancer by magnetic resonance imaging-transrectal ultrasound fusion guided biopsy was 77% for prostate glands less than 30 cm<sup>3</sup>, and 61%, 47% and 34% for glands 30 to less than 38.5, 38.5 to less than 55 and 55 to 160 cm<sup>3</sup>, respectively (p = 0.001). Differences in prostate cancer detection rates between the standard and targeted protocols were not significant for patients with a prostate volume of 40 cm<sup>3</sup> or less (p = 0.8). Conversely 12 patients with a prostate volume greater than 40 cm<sup>3</sup> had clinically significant prostate cancer using the targeted but not the standard protocol and in 3 prostate cancer was detected by the standard but not the targeted protocol (p = 0.04). Conclusions Magnetic resonance imaging-transrectal ultrasound fusion biopsies increased the yield of first round prostate biopsies in patients with a prostate volume greater than 40 cm<sup>3</sup>.

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