[46] Cognitive transrectal ultrasonography-guided targeted prostate needle biopsies based on multi-parametric magnetic resonance imaging findings: Initial experience

Objective: To report an initial experience of cognitive transrectal ultrasonography-guided targeted prostate needle biopsies based on multi-parametric magnetic resonance imaging (mpMRI) findings. Random biopsy of the prostate is a crude way to identify prostate cancer hoping to hit the area of disease and hence the yield has never exceeded 30%. The introduction of mpMRI has tremendously enhanced our ability to identify specific suspicious areas with significant disease [Prostate Imaging - Reporting and Data System (PI-RADS) 4 and 5] and to target those areas thus improving the detection of significant disease with fewer biopsies. Methods: In all, 97 consecutive patients with elevated prostate-specific antigen levels and suspicious mpMRI underwent targeted biopsies from the suspicious lesion (∼five) and two random biopsies from the non-suspicious areas. The biopsies were performed using cognitive identification of the suspected area on MRI by a team comprised of a Urologist and Radiologist. All patients had routine pre-biopsy preparation. Results: In all, 55 of 97 patients (57%) had positive biopsies, whilst 41/97 patients (42%) had negative biopsies, and two patients had atypical small acinar proliferation. The median number of cores taken was seven. Of the 55 patients with positive biopsies, 42 had significant Gleason grade ⩾7 disease, 27 had bilateral disease and in 11 of these 27 one contralateral side was negative on MRI but positive at biopsy. Conclusion: Cognitive-targeted biopsies of the prostate based on pre-biopsy MRI mapping for suspicious areas has tremendously enhanced our yield of important disease detection and not insignificant ones. In addition, this is done with fewer biopsies thus reducing potential complications