Value of Systematic and MRI-Ultrasound Fusion Prostate Biopsy in Different Prostate Specific Antigen (PSA) Levels

Current approach to clinically suspicious biopsy-naïve men consists performing prostate MRI, followed by combined systematic (TRUS-Bx) and MRI-Ultrasound fusion biopsy (MRI-TBx) in those with PIRADS score ≥ 3. Researchers have attempted to determine who benefits from each biopsy method, but the results do not support the safe use of one method alone. This study aims to determine the optimal approach in biopsy-naïve men, according to their PSA levels.

A retrospective chart review of clinically suspicious biopsy-naïve men who underwent both TRUS-Bx and MRI-TBx was done. Prostate specific antigen (PSA) levels were compared between patients only positive for MRI-TBx and those with positive TRUS-Bx. Further, cancer cases were divided to < 10 and ≥ 10 PSA groups and the pathology results, obtained by each method, were compared. Out of 195 men, 36 were diagnosed with prostate cancer (PCa). PCa was diagnosed by both MRI-TBx and TRUS-Bx in 26 men, half of whom had PSA > 10 ng/mL. At PSA ≤ 10 ng/mL, PCa would have been missed in 4 men (11.1%) had MRI-TBx not been done, and in 6 men (16.6%) had TRUS-Bx not been done.

Despite attempts to perform only one biopsy method in men with clinical suspicion of prostate cancer, we propose that at least in men with PSA ≤ 10 ng/mL, both systematic and MRI-targeted biopsies be performed.