Material and Methods
We retrospectively reviewed completely anonymized data from nation-wide
tertiary centers in Prostate Cancer Database of Turkish Urooncology
Association. MRI targeted biopsy is limited yet in this country and
several centers are using conventional 12-core transrectal
ultrasound-guided prostate biopsy (TRUS-Bx) protocol without mpMRI for
the diagnosis of prostate cancer. Therefore our prostate biopsy database
has two different data entry: first separately from conventional TRUS-Bx
without mpMRI and second MRI fusion biopsy (combined targeted and
concomitant systematic biopsies) registered accordingly from
collaborating centers in our database. Biopsy naive patients who were
diagnosed with prostate cancer either with conventional TRUS-Bx or
MRI-Targeted biopsy combined with systematic 12-core biopsy (TBx + SBx)
and underwent radical prostatectomy (RP) between 2017-2020 were
evaluated in this study. Cognitive MRI fusion biopsies were excluded.
Patients who had PSA level less than 20 ng/ml were included in the study
to exclude high grade advanced PCa to ensure proportional distribution
of PCa grades between biopsy methods. Patients who had complete
pathological data of each Bx scheme and data of RP were investigated.
The patients’ age, PSA level, the highest GS and ISUP grades from each
Bx scheme, RP pathology and upgrade/downgrade ratios were assessed.
Patients were divided into two groups as Combined TBx + SBx and
conventional TRUS-Bx method. Data were compared between these groups.
Also, a sub-group analysis of the concordance of ISUP grades, upgrade,
downgrade ratios between TBx alone, SBx alone and combination TBx + SBx
scheme was investigated.
All TRUS-Bx biopsies were taken with a transrectal approach under local
anesthesia using the 12 core approach. All mpMRI for targeted biopsies
were reviewed by a specified institutional radiologist. In patients with
a PI-RADS-lesion ≥3 (according to PI-RADS-v2 classification) (15), MRI
Targeted ultrasound fusion biopsy using different software-based
platforms according to participant center’s property MIMS Symphony Dx®
(MIM Software), bk3000® (BKMedical), UroNav® (Invivo Corp, Philips) was
conducted. MRI image fusion targeted biopsies were taken from each
target with at least 2 or more core samples from each target lesion. In
addition to targeted biopsies, systematic random biopsies were also
performed using the 12-core approach.
The biopsy GS was defined as the highest Gleason score in at least one
core and was reported using the ISUP Consensus Conference 2014 grading
system (16).