A Comparative Study: Has MRI-guided Fusion Prostate Biopsy Changed the Prostate-specific Antigen Gray-zone Range?

Area of Science:

• Urology
• Oncology
• Medical Imaging

Background:

• The gray-zone for prostate-specific antigen (PSA) levels (4-10 ng/ml) presents diagnostic challenges.
• Traditional standard prostate biopsy (SPB) has limitations in cancer detection within this range.
• Multiparametric magnetic resonance imaging (MpMRI) guided fusion prostate biopsy (FPB) offers potentially higher cancer detection rates.

Purpose of the Study:

• To evaluate the impact of fusion prostate biopsy (FPB) on the gray-zone prostate-specific antigen (PSA) cut-off value.
• To compare cancer detection rates between standard prostate biopsy (SPB) and FPB in patients with PI-RADS ≥3 lesions.

Main Methods:

• Retrospective analysis of 1,628 patients undergoing either SPB or MpMRI-guided FPB.
• Patients in the FPB group had PI-RADS ≥3 lesions identified on MpMRI.
• Demographic, clinical, and histopathological data were collected and analyzed.

Main Results:

• Prostate cancer (PCa) detection was higher in the FPB group (42.4%) compared to the SPB group (36.4%).
• The PSA cut-off value for PCa detection was significantly lower in the FPB group (7.55 ng/ml) versus the SPB group (9.75 ng/ml).
• In the FPB group, 56.1% of cancers were detected in patients with PSA levels between 7.55-10.00 ng/ml.

Conclusions:

• Fusion prostate biopsy (FPB) demonstrates superior cancer detection capabilities.
• FPB effectively lowers the upper limit of the gray-zone PSA range, enhancing diagnostic accuracy.
• The integration of FPB refines PSA interpretation for improved prostate cancer diagnosis.