PDF icon Download PDF
Open Access
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2025; 35(03): 387-394
DOI: 10.1055/s-0044-1796642
Original Article

A Prospective Comparison of MRI-Guided Targeted Biopsy with 12-Core Transrectal Ultrasound-Guided Systematic Biopsy in the Diagnosis of Clinically Significant Prostate Cancer: An Indian Experience

Arjunlokesh Netaji
1   Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Vijay Kubihal 
1   Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Raju Sharma
1   Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Amlesh Seth
2   Department of Urology, All India Institute of Medical Sciences, New Delhi, India
,
Seema Kaushal
3   Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
,
Chandan J. Das 
1   Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
Funding None.
› Further Information
Also available ateRefMedOne
  Permissions and Reprints
Preview

Abstract

Objective The aim of this study was to compare the sensitivity and prostate cancer detection rate of magnetic resonance (MR) in-bore biopsy with transrectal ultrasound (TRUS) guided systematic biopsy. We also compared the cancer detection rate of the combined MR in-bore and TRUS-guided systematic biopsy with the TRUS-guided biopsy only approach.

Materials and Methods In this prospective study, 61 consecutive patients with prostate-specific antigen (PSA) ≥ 3 ng/mL and Prostate Imaging Reporting and Data System (PI-RADS) score ≥4 were recruited between July 2017 and January 2020. One patient with prior prostate surgery was excluded. Among the remaining 60 patients, 30 underwent MR in-bore biopsy followed by systematic biopsy (study arm A) and 30 underwent systematic biopsy only (study arm B).

Results The mean PSA range of study population (n = 60 patients) was 4.2 to 72.7 ng/mL. Twenty-seven patients had a PI-RADS score of 4, and 33 patients had a PI-RADS score of 5. Among 60 patients, 30 had prostate carcinoma on biopsy, of which 18 were clinically significant prostate cancers (csPCa). In study arm A, TRUS-guided systematic biopsy had a lower sensitivity (0.9) for detection of csPCa compared with MR in-bore biopsy (1.0) with overdetection of insignificant cancers (sensitivity: 0.89 vs. 0.56). TRUS-guided biopsy yielded 112 positive cores out of 360, whereas MR in-bore biopsy yielded 15 positive cores out of 30 (31.1 vs. 50%; p = 0.03). On comparison of study arms A and B, the diagnostic yield for detection of both prostate cancer and csPCa were high in study arm A (60 vs. 40%, and 33.3 vs. 26.7%, respectively)

Conclusion MRI in-bore targeted biopsy had a greater sensitivity to detect csPCa with fewer number of biopsy cores and lower sensitivity to detect insignificant cancers compared with systematic biopsy. Systematic biopsies were associated with overdetection of clinically insignificant cancers.

Keywords

MRI - MRI in-bore biopsy - prostate cancer - systematic biopsy - targeted biopsy - transrectal ultrasound


Publication History

Article published online:
11 December 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 World Cancer Research Fund. Prostate cancer statistics. 2019 . Accessed November 11, 2024 at: https://www.wcrf.org/dietandcancer/cancer-trends/prostate-cancer-statistics
    Search in Google Scholar
  • 2 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020; 70 (01) 7-30
    Search in Google Scholar
  • 3 Lane BR, Zippe CD, Abouassaly R, Schoenfield L, Magi-Galluzzi C, Jones JS. Saturation technique does not decrease cancer detection during followup after initial prostate biopsy. J Urol 2008; 179 (05) 1746-1750 , discussion 1750
    Search in Google Scholar
  • 4 Jones JS. Saturation biopsy for detecting and characterizing prostate cancer. BJU Int 2007; 99 (06) 1340-1344
    Search in Google Scholar
  • 5 Dickinson L, Ahmed HU, Allen C. et al. Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting. Eur Urol 2011; 59 (04) 477-494
    Search in Google Scholar
  • 6 Delongchamps NB, Rouanne M, Flam T. et al. Multiparametric magnetic resonance imaging for the detection and localization of prostate cancer: combination of T2-weighted, dynamic contrast-enhanced and diffusion-weighted imaging. BJU Int 2011; 107 (09) 1411-1418
    Search in Google Scholar
  • 7 Rosenkrantz AB, Deng F-M, Kim S. et al. Prostate cancer: multiparametric MRI for index lesion localization: a multiple-reader study. AJR Am J Roentgenol 2012; 199 (04) 830-837
    Search in Google Scholar
  • 8 Rosenkrantz AB, Verma S, Choyke P. et al. Prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a prior negative biopsy: a consensus statement by AUA and SAR. J Urol 2016; 196 (06) 1613-1618
    Search in Google Scholar
  • 9 Ahmed HU, El-Shater Bosaily A, Brown LC. et al; PROMIS study group. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017; 389 (10071): 815-822
    Search in Google Scholar
  • 10 Kasivisvanathan V, Rannikko AS, Borghi M. et al; PRECISION Study Group Collaborators. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 2018; 378 (19) 1767-1777
    Search in Google Scholar
  • 11 Yao N, Hu H, Chen K. et al. A robust deep learning method with uncertainty estimation for the pathological classification of renal cell carcinoma based on CT images. J Imaging Inform Med 2025;38(03):1323–1333
  • 12 Verma S, Choyke PL, Eberhardt SC. et al. The current state of MR imaging-targeted biopsy techniques for detection of prostate cancer. Radiology 2017; 285 (02) 343-356
    Search in Google Scholar
  • 13 Das CJ, Razik A, Netaji A, Verma S. Prostate MRI-TRUS fusion biopsy: a review of the state of the art procedure. Abdom Radiol (NY) 2020; 45 (07) 2176-2183
    Search in Google Scholar
  • 14 Etzioni R, Penson DF, Legler JM. et al. Overdiagnosis due to prostate-specific antigen screening: lessons from U.S. prostate cancer incidence trends. J Natl Cancer Inst 2002; 94 (13) 981-990
    Search in Google Scholar
  • 15 Ploussard G, Epstein JI, Montironi R. et al. The contemporary concept of significant versus insignificant prostate cancer. Eur Urol 2011; 60 (02) 291-303
    Search in Google Scholar
  • 16 Efesoy O, Bozlu M, Çayan S, Akbay E. Complications of transrectal ultrasound-guided 12-core prostate biopsy: a single center experience with 2049 patients. Turk J Urol 2013; 39 (01) 6-11
    Search in Google Scholar
  • 17 Borghesi M, Ahmed H, Nam R. et al. Complications after systematic, random, and image-guided prostate biopsy. Eur Urol 2017; 71 (03) 353-365
    Search in Google Scholar
  • 18 Wegelin O, van Melick HHE, Hooft L. et al. Comparing three different techniques for magnetic resonance imaging-targeted prostate biopsies: a systematic review of in-bore versus magnetic resonance imaging-transrectal ultrasound fusion versus cognitive registration. is there a preferred technique?. Eur Urol 2017; 71 (04) 517-531
    Search in Google Scholar
  • 19 Siddiqui MM, Rais-Bahrami S, Turkbey B. et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA 2015; 313 (04) 390-397
    Search in Google Scholar
  • 20 Wysock JS, Rosenkrantz AB, Huang WC. et al. A prospective, blinded comparison of magnetic resonance (MR) imaging-ultrasound fusion and visual estimation in the performance of MR-targeted prostate biopsy: the PROFUS trial. Eur Urol 2014; 66 (02) 343-351
    Search in Google Scholar
  • 21 van der Leest M, Cornel E, Israël B. et al. Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naïve men with elevated prostate-specific antigen: a large prospective multicenter clinical study. Eur Urol 2019; 75 (04) 570-578
    Search in Google Scholar
  • 22 Arsov C, Rabenalt R, Blondin D. et al. Prospective randomized trial comparing magnetic resonance imaging (MRI)-guided in-bore biopsy to MRI-ultrasound fusion and transrectal ultrasound-guided prostate biopsy in patients with prior negative biopsies. Eur Urol 2015; 68 (04) 713-720
    Search in Google Scholar
  • 23 de Rooij M, Crienen S, Witjes JA, Barentsz JO, Rovers MM, Grutters JPC. Cost-effectiveness of magnetic resonance (MR) imaging and MR-guided targeted biopsy versus systematic transrectal ultrasound-guided biopsy in diagnosing prostate cancer: a modelling study from a health care perspective. Eur Urol 2014; 66 (03) 430-436
    Search in Google Scholar
  • 24 Faria R, Soares MO, Spackman E. et al. Optimising the diagnosis of prostate cancer in the era of multiparametric magnetic resonance imaging: a cost-effectiveness analysis based on the Prostate MR Imaging Study (PROMIS). Eur Urol 2018; 73 (01) 23-30
    Search in Google Scholar
  • 25 Venderink W, van der Leest M, van Luijtelaar A. et al. Retrospective comparison of direct in-bore magnetic resonance imaging (MRI)-guided biopsy and fusion-guided biopsy in patients with MRI lesions which are likely or highly likely to be clinically significant prostate cancer. World J Urol 2017; 35 (12) 1849-1855
    Search in Google Scholar
  • 26 Wegelin O, Exterkate L, van der Leest M. et al. The FUTURE trial: a multicenter randomised controlled trial on target biopsy techniques based on magnetic resonance imaging in the diagnosis of prostate cancer in patients with prior negative biopsies. Eur Urol 2019; 75 (04) 582-590
    Search in Google Scholar
  • 27 Moore CM, Kasivisvanathan V, Eggener S. et al; START Consortium. Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. Eur Urol 2013; 64 (04) 544-552
    Search in Google Scholar