Outcomes of Multi-parametric MRI-US Cognitive Fusion Transperineal Prostate Biopsy | Chapter 09 | New Horizons in Medicine and Medical Research Vol. 7

 

The goal of this study was to present the results of a single tertiary institution's multi-parametric Magnetic Resonance Imaging-Ultrasound (mpMRI-US) Cognitive Fusion Template-guided Transperineal Prostate Biopsy (TPB).

Retrospective study design.

Study Location and Duration: Between April 2017 and December 2019, a sample was taken from the Department of Urology at the Kuala Lumpur General Hospital.

Methodology: Patients who received mpMRI-US cognitive fusion template-guided TPB and had Prostate Imaging-Reporting and Data System (PI-RADS) 3-5 on mpMRI were retrospectively recruited. The data was analysed to see how often PCa was detected, how accurate mpMRI diagnostics were, and how often post-TPB complications were. Gleason 3+4 was used to define clinically significant PCa (csPCa).

A total of 122 patients were included in the study, with 330 PI-RADS 3-5 lesions assessed. The average age was 66, the average prostate specific antigen concentration was 15.5 ng/mL, and 56.6 biopsy cores were used on average. The participants included 54.1 percent Chinese, 38.5 percent Malays, 4.9 percent Indians, and 2.5 percent Others. Repeat biopsy (70.5%), biopsy naive (21.3%), and re-staging (21.3%) were the three groupings (8.2 percent ). The overall detection rates for PCa and csPCa were 43.4 percent and 24.6 percent, respectively. In PI-RADS 3, 4, and 5, csPCa was found in 43.8 percent, 48.6 percent, and 66.7 percent, respectively. mpMRI missed 19.4% of PCa, with Gleason accounting for 66.7 percent of them. 6. Disease upstaged in 50% of active surveillance patients. mpMRI demonstrated an 87 percent sensitivity, 86.1 percent specificity, 13.1 percent positive predictive value, and 99.6 percent negative predictive value for csPCa detection. Age (P.001), Indian race (P =.007), and prostate volume (P.001) were all statistically significant on multivariate analysis. There was no death, and the complication incidence was low (4.9 percent acute urinary retention, 9 percent hematuria, and 0.8 percent infection).

Conclusion: The use of mpMRI for csPCa detection is critical. The more PI-RADS, the more csPCa was discovered. Our experience with MRI-US cognitive fusion template-guided TPB gives consistent results with other research in terms of total PCa detection, detection rate of low-grade PCa in'missed' lesions in mpMRI, correlation between PCa detection and greater prostate size, and diagnostic accuracy of mpMRI. We also discovered that mpMRI had a high diagnostic accuracy for PCa detection and had low TPB complication rates.

Author(S) Details

Mohd Najib Aziz
Department of Urology, Kuala Lumpur General Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia.

Vijayan Manogran
Department of Urology, Kuala Lumpur General Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia.

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