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

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.