Outcomes of Multi-parametric MRI-US Cognitive Fusion Transperineal Prostate Biopsy

Aims: The aim of this study was to report the outcomes of multi-parametric Magnetic Resonance Imaging-Ultrasound (mpMRI-US) Cognitive Fusion Template-guided Transperineal Prostate Biopsy (TPB) performed in a single tertiary institution. Study Design: Retrospective. Place and Duration of Study: Sample: Department of Urology, Kuala Lumpur General Hospital, between April 2017 and December 2019. Methodology: Patients with Prostate Imaging-Reporting and Data System (PI-RADS) 3-5 on mpMRI who had mpMRI-US cognitive fusion template-guided TPB were retrospectively recruited. The information was evaluated to determine the rate of PCa detection, mpMRI diagnostic accuracy, and post-TPB complication rates. Clinically significant PCa (csPCa) was defined as Gleason 3+4. Results: A total of 122 patients were enrolled, with 330 PI-RADS 3-5 lesions being examined. The average age was 66, the average prostate specific antigen concentration was 15.5 ng/mL, and the average number of biopsy cores was 56.6. 54.1 percent of the participants were Chinese, 38.5 percent were Malays, 4.9 percent were Indian, and 2.5 percent were Others. There were three subgroups: repeat biopsy (70.5%), biopsy naive (21.3%), and re-staging (8.2%). Overall PCa and csPCa detection rates were 43.4 percent and 24.6 percent, respectively. csPCa was detected in 43.8%, 48.6% and 66.7% in PI-RADS 3, 4 and 5 respectively. mpMRI missed 19.4% of PCa, of these 66.7% was Gleason 6. 50% patients on active surveillance had disease upstaged. For csPCa detection, mpMRI had a sensitivity of 87%, specificity of 86.1%, positive predictive value of 13.1% and negative predictive value of 99.6%. On multivariate analysis, age (P < .001), Indian race (P = .007) and prostate volume (P < .001) were statistically significant. The complication rate was minimal (4.9 percent acute urinary retention, 9 percent hematuria, and 0.8 percent infection), and there was no fatality. Conclusion: The use of mpMRI in the detection of csPCa is crucial. The greater the PI-RADS, the more csPCa was found. In terms of overall PCa detection, detection rate of low-grade PCa in 'missed' lesions in mpMRI, correlation between PCa detection and larger prostate size, and diagnostic accuracy of mpMRI, our experience with MRI-US cognitive fusion template-guided TPB yields a consistent result with other studies. We also found that mpMRI had a good diagnostic accuracy in detecting PCa and reported minimal TPB complication rates.