Accuracy of real-time magnetic resonance imaging-transrectal ultrasound fusion image-guided transperineal target biopsy with needle tracking with a mechanical position-encoded stepper in detecting significant prostate cancer in biopsy-naïve men.

Objective To evaluate the accuracy of real-time elastic fusion image-guided transperineal prostate biopsy with needle tracking involving a mechanical position-encoded stepper in detecting clinically significant prostate cancer for biopsy-naïve men. Methods We prospectively recruited patients with serum prostate-specific antigen levels of 4.0-20 ng/mL and suspicious of prostate cancer on multiparametric magnetic resonance imaging. They underwent targeted biopsies for cancer-suspicious lesions and 12-core systematic biopsies. Pathological findings from biopsy cores and whole-mount specimens (for those who underwent radical prostatectomy) were analyzed. Results A total of 250 patients were included, in whom targeted and systematic biopsies detected significant cancers in 55% and 25%, respectively ( P < 0.001). The targeted biopsy cores ( n = 527) showed significantly greater biopsy-proven significant cancer detection rates ( P < 0.001), cancer core length ( P < 0.0001), cancer core percentage ( P < 0.001) and Gleason scores ( P < 0.001) than did the systematic biopsies. The significant cancer detection rate for targeted lesions (those with Prostate Imaging and Reporting and Data System classification scores of 5) was 80%. Biopsy-proven significant cancer detection rates for targeted lesions ≤10 mm and >10 mm were similar for Prostate Imaging and Reporting and Data System scores of 4 ( P = 0.707) and 5 ( P = 0.386). In whole-mount specimens ( n = 30), locations for 95% of significant cancers were diagnosed preoperatively. Targeted biopsies alone diagnosed 79% of significant cancers. Conclusions Although targeted biopsies are superior to systematic biopsies in detecting significant cancers, systematic biopsies maintain an important role in the diagnosis of prostate cancer in biopsy-naïve men. [ABSTRACT FROM AUTHOR]