Detection Of Clinically Significant Prostate Cancer In Biopsy-Naive Men: Direct Comparison Of Systematic Biopsy, Multiparametric Mri- And Contrast-Ultrasound-Dispersion Imaging-Targeted Biopsy

Objectives To compare and evaluate a multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy (TBx) strategy, contrast-ultrasound-dispersion imaging (CUDI)-TBx strategy and systematic biopsy (SBx) strategy for the detection of clinically significant prostate cancer (csPCa) in biopsy-naive men.Patients and Methods A prospective, single-centre paired diagnostic study included 150 biopsy-naive men, from November 2015 to November 2018. All men underwent pre-biopsy mpMRI and CUDI followed by a 12-core SBx taken by an operator blinded from the imaging results. Men with suspicious lesions on mpMRI and/or CUDI also underwent MRI-TRUS fusion-TBx and/or cognitive CUDI-TBx after SBx by a second operator. A non-inferiority analysis of the mpMRI- and CUDI-TBx strategies in comparison with SBx for International Society of Urological Pathology Grade Group [GG] >= 2 PCa in any core with a non-inferiority margin of 1 percentage point was performed. Additional analyses for GG >= 2 PCa with cribriform growth pattern and/or intraductal carcinoma (CR/IDC), and GG >= 3 PCa were performed. Differences in detection rates were tested using McNemar's test with adjusted Wald confidence intervals.Results After enrolment of 150 men, an interim analysis was performed. Both the mpMRI- and CUDI-TBx strategies were inferior to SBx for GG >= 2 PCa detection and the study was stopped. SBx found significantly more GG >= 2 PCa: 39% (56/142), as compared with 29% (41/142) and 28% (40/142) for mpMRI-TBx and CUDI-TBx, respectively (P < 0.05). SBx found significantly more GG = 1 PCa: 14% (20/142) compared to 1% (two of 142) and 3% (four of 142) with mpMRI-TBx and CUDI-TBx, respectively (P < 0.05). Detection of GG >= 2 PCa with CR/IDC and GG >= 3 PCa did not differ significantly between the strategies. The mpMRI- and CUDI-TBx strategies were comparable in detection but the mpMRI-TBx strategy had less false-positive findings (18% vs 53%).Conclusions In our study in biopsy-naive men, the mpMRI- and CUDI-TBx strategies had comparable PCa detection rates, but the mpMRI-TBX strategy had the least false-positive findings. Both strategies were inferior to SBx for the detection of GG >= 2 PCa, despite reduced detection of insignificant GG = 1 PCa. Both strategies did not significantly differ from SBx for the detection of GG >= 2 PCa with CR/IDC and GG >= 3 PCa.