Evaluation of the Performance of Systematic Sampling Combined With MRI-TRUS Fusion Biopsy and Concordance After...

MRI-guided prostate biopsy allows the targeted sampling of suspicious lesions. However, limitations of MRI and MRI-TRUS fusion biopsy techniques may lead to an underdiagnosis, and thus, some patients may benefit from combining systematic sampling with targeted sampling during prostate biopsy. We aim to assess the diagnostic yield of systematic sampling on MRI-TRUS fusion biopsy pathological result and the histopathological concordance after radical prostatectomy.

We retrospectively compared the prostate cancer (PCa) and clinically significant prostate cancer (csPCa) detection rate (CDR) during the MRI-TRUS fusion biopsy in the targeted sampling with the combination of targeted and systematic samplings. A subgroups analysis was performed considering the PSA density, PIRADS score and the personal history of previous biopsies. We also evaluated the concordance after radical prostatectomy.

188 patients submitted to targeted and systematic sampling during the MRI-TRUS fusion biopsy were included. Overall increases of 5.8% and 2.2% in terms of CDR of PCa and csPCa were observed by adding a systematic sampling over the targeted one. Patients with a PIRADS score 4 to 5, PSA density ≥ 0.15 ng/mL², or a history of biopsy showed a significant increase in CDR. Combining systematic sampling with targeted sampling improved the concordance in ISUP grade by 10% (43.6% vs 33.3%) and the kappa statistic by 0.08 (0.20 vs. 0.12).

In our experience, the combination of systematic sampling improves the cancer detection rate, especially in patients with highly suspicious radiological findings or a history of biopsy, and increases the concordance after radical prostatectomy.