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).