MRI/US Imaging Fusion Guided Transperineal Prostate Biopsy:a Clinical Research In Single Center

Objective:To analyze and evaluate the efficacy of Magnetic resonance imaging/Ultrasound (MRI/US) imaging fusion guided transperineal prostate biopsy for the diagnosis of prostate cancer.Methods:From September 2014 to February 2016,485 cases were hospitalized for prostate biopsy and their data was analyzed retrospectively, with 121 cases who underwent MRI/US imaging fusion guided transperineal prostate biopsy(Group One),57 cases who underwent US guided transperineal prostate biopsy(Group Two), and 307 cases who underwent US guided transrectal prostate biopsy(Group Three). Each case of Group One underwent systematic 12-core biopsy(SB) add 2-core targeting biopsy(TB) per region of interest(ROI), and each case of Group Two and Group Three only underwent SB. Pathological findings of each biopsy core was analyzed for Gleason grade and the single-core length of prostate cancer. We recorded the clinical, imaging and pathological data of all cases. We analyzed various data of three groups by analysis of variance and chi-square test, and the data of SB and TB of Group One by Student's t test, rank sum test and chi-square test.Results:There were no statistical differences between three groups in term of age, total prostate specific antigen(tPSA) level and prostate volume(P> 0.05). Group One had a higher positive rate for prostate cancer(38.0%), higher rate for high-risk prostate cancer(22.3%) and lower rate for missed prostate cancer(5.6%) compared with Group Two(28.1%,22.1% and 5.9%) and Group Three(37.8%,20.8% and 12.5%), with the difference not statistically significant(P>0.05). In Group One, TB had an obvious higher single-core positive rate for prostate cancer(20.0%) and an obvious higher single-core positive rate for high-risk prostate cancer(10.3%) than SB(12.7% and 5.5%), with the difference statistically significant (P= 0.001 and P= 0.002). In Group One, TB had a higher single-core length of prostate cancer than SB, with the difference statistically significant (P=0.046). In Group One, positive cores of TB had a higher primary Gleason grade, secondary Gleason grade, and Gleason score compared with positive cores of SB, with the difference not statistically significant (P> 0.05). In Group One, the coincidence rate for the risk degree of the highest Geason score of TB with the risk degree of the radical pathological Geason score(39.3%) was lower than that for the risk degree of the highest Geason score of SB with the risk degree of the radical pathological Geason score(50.0%), with the difference not statistically significant (P> 0.05).Conclusion:TB in MRI/US imaging fusion guided transperineal prostate biopsy can detect high-risk prostate cancer with fewer cores, capable to offer a better guidance for further diagnosis and treatment. The combination of TB and SB in MRI/US imaging fusion guided transperineal prostate biopsy can reduce rate for missed prostate cancer. MRI/US imaging fusion guided transperineal prostate biopsy has similar positive rate for prostate cancer with traditional US guided prostate biopsy, and this new technique is worth promoting if it is permitted.