Diagnostic value of transperineal MRI/US Fusion biopsies in patients with risk of prostate cancer and prior negative biopsies

Transrectal prostate biopsies provide false-negative results in 20-30% of cases. The aim of the study was to evaluate efficacy of transperineal MRI/US Fusion biopsies using multiparametric magnetic resonance imaging (mpMRI) in patients with prior negative prostate biopsies who are at risk of prostate cancer (PC). Patients from one clinical center during year 2019 to 2020 with high risk of prostate cancer, prior negative prostate biopsies, prostate mpMRI examination with PIRADS score 3 or higher and prostate biopsy using transperineal MRI/US Fusion approach were included in our retrospective analysis. Patient’s age, PSA blood levels, mpMRI data (number of lesions, prostate volume), biopsy data (time of procedure) were analysed. All patients were divided in three categories according to PIRADS score. IBM SPSS 22 was used for statistical analysis. Our group consisted of 96 patients with average age of 66,8±SD 7,2 years, with average PSA of 11,3 ±10,2 ng/ml and prostate volume of 63,7±35,6 cm3. 55,2% (n=53) of patients had one lesion, 30,2% (n=29) had two lesions, 12,5% (n=12) had three lesions, 2,1% (n=2) had four lesions. Average time of transperineal biopsy procedure was 28,5±13,6 minutes. Mean number of targeted biopsies per patient was 7,5±3,1. 60,4% of all patients (n=58) had PC, with 39,6% (n=38) clinically significant PC. In PIRADS 3 group PC was found in 22,2% (n=4) cases, clinically significant PC 11,1% (n=2), in PIRADS 4 group 53,8% (n=21) and clinically significant PC 30,8% (n=12) respectively, in PIRADS 5 group 87,2% (n=34) and clinically significant PC 61,5% (n=24). In our study group transperineal biopsy procedure identified clinically significant prostate cancers in all PIRADS score categories, especially in PIRADS 5 group. Therefore transperineal biopsies using MRI/US Fusion biopsy provides additional diagnostic value in patients with previous negative biopsies and risk of prostate cancer.