Utility Of Targeted Biopsy Techniques Based On Multiparametric Magnetic Resonance Imaging In The Diagnosis Of Prostate Cancer In Biopsy-Naive Patients:A Multicenter Retrospective Study

Objective:To investigate the diagnostic value of targeted prostate biopsy techniques based on multiparametric magnetic resonance imaging(mpMRI)in biopsy-naive patients.Materials and Methods:Retrospectively reviewed the data of patients who underwent prostate biopsy in the First Affiliated Hospital of Soochow University,the Second Affiliated Hospital of Soochow University and Traditional Chinese Medicine Hospital of Kunshan between October 2015 and January 2021.Patients with total prostate specific antigen(tPSA)up to 20ng/ml and no prior biopsy history were enrolled.Patients with negative mpMRI(PI-RADS≤2)results had systematic biopsy(SB)only,others with positive mpMRI(PI-RADS≥3)results underwent mpMRI based targeted biopsy(MRI-TB)followed by SB.We enrolled 1585 cases in all among which 1101 had positive mpMRI results.Comparison of MRI-TB and SB in detecting overall prostate cancer(PCa),clinically significant prostate cancer(csPCa)and clinically insignificant prostate cancer(cisPCa)were analyzed respectively.In the sub-group analysis,differences between each MRI-TB,SB techniques as well as biopsy pathway were compared for the purpose of identifying the optimal biopsy technique.Moreover,in the mpMRI negative group,the negative predictive value(NPV)of mpMRI for PCa and csPCa were calculated respectively.We also made effort to explore potential parameters for further risk stratification in order to optimize the NPV of mpMRI.Results:Cancer detection rate(CDR)for overall PCa in MRI-TB techniques was significantly lower than SB[42.1%(462/1101)vs 49.1%(541/1101),P<0.05],there was no significant difference in the CDR of csPCa between two protocols[37.3%(411/1101)vs 41.1%(452/1101),P=0.073],CDR for cisPCa in MRI-TB was significantly lower than SB[4.6%(51/1101)vs 8.0%(89/1101),P<0.05].Altogether 16010 biopsy cores were obtained and significantly higher positive rate of MRI-TB cores was observed than SB cores[38.2%(1042/2726)vs 17.4%(2312/13284),P<0.05].In the sub-group analysis of MRITB techniques,cognitive registration targeted biopsy(COG-TB)demonstrated higher CDR for csPCa compared with MRI and ultrasound fusion targeted biopsy(FUS-TB)[44.3%(206/465 vs 32.2%(205/636,P<0.05],so was the positive rate of biopsy cores[62.7%(52/83)vs 40.3%(154/382),P<0.05].Besides,transperineal COG-TB seemed to be much better than transrectal pathway[62.7%(52/83)vs 40.3%(154/382),P<0.05].In the subgroup analysis of SB techniques,CDR for csPCa of transrectal systematic prostate biopsy(TRPB)was significantly higher than transperineal systematic prostate biopsy(TPPB)[45.8%(175/382)vs 38.5%(277/719),P<0.05].In the mpMRI negative group,67 cases(7.4%,36/484)of any PCa were detected by SB,of which 36(7.4%,36/484)were csPCa,the NPV of mpMRI for PCa and csPCa were 82.6%and 92.6%respectively.If combined with PSAD,the NPV further improved to 96.1%,97.8%in cases with PSAD<0.15ng/ml/cm3 and 98.3%,99.0%in cases with PSAD<0.10ng/ml/cm3.Conclusion:MRI-TB achieved similar CDR for csPCa with minimal biopsy cores and avoided over detection of cisPCa compared with SB,combination of MRI-TB and SB can reach the highest CDR.Compared with FUS-TB,the CDR of COG-TB was significantly higher,especially the transperineal pathway COG-TB.The positive rate of biopsy cores was higher for COG-TB as well.Besides,TRPB detected more csPCa than TPPB.If use mpMRI as a triage tool,28.3%patients could avoid unnecessary biopies.In the mpMRI negative group,the NPV of mpMRI for PCa and csPCa improved to 96.1%,97.8%in cases with PSAD<0.15ng/ml/cm3 and 98.3%,99.0%in cases with PSAD<0.10ng/ml/cm3,more prospective studies are needed to vertify our findings.