Free-hand transperineal targeted prostate biopsy with real-time fusion imaging of multiparametric magnetic resonance imaging and transrectal ultrasound: single-center experience in China.

Objectives: To report our experience with free-hand transperineal targeted biopsy with real-time transrectal ultrasound (TRUS) and multiparametric magnetic resonance imaging (mpMRI) fusion images for the diagnosis of prostate cancer (PCa).
Patients and Methods: A total of 62 consecutive patients suspicious of PCa at the mpMRI scan and PSA >4.0 ng/mL were recruited prospectively. Targeted biopsies (TBs) were carried out for each cancer-suspicious lesion and followed a 12-core systematic biopsy (SB) protocol. Pathological findings of TB and SB were analyzed.
Results: The age of the patients was 68.38 ± 6.57 years (range 51-79 years). The preoperative PSA value was 10.21 ± 5.57 ng/mL (range 4.5-30.1 ng/mL). Preoperative prostate volume was 34.05 ± 9.86 mL (range 19-64 mL). The PCa patients detected by SB and/or TB were 34 (54.8%). Cancer-detected rates of SB and TB cores were 7.53 and 26.2%, respectively (P < 0.001). The positive core length of SB and TB cores was 3.71 ± 2.77 mm (range 1-14 mm) and 5.00 ± 3.04 mm (range 2-17 mm), respectively (P = 0.016). The positive core percent of SB and TB cores was 28.77 ± 20.13% (range 7-100%) and 35.76 ± 18.73 (range 11-100%), respectively (P = 0.048). Moreover, clinically significant PCa cores detected by the SB and TB were 19 cores (2.6%) and 48 cores (18.5%), respectively (P < 0.001).
Conclusions: Free-hand transperineal TB using real-time TRUS and mpMRI fusion imaging has the ability to improve sampling quality and detect more clinically significant PCa compared with SB.