A prospective comparison of transrectal standard, cognitive, transperineal fusion and mapping prostate biopsy for cancer detection.

Purpose The aim of this research was to compare the csPCa detection rate (ISUP≥2) for the 4 biopsy methods: TRUS-GB, COG-TB, FUS-TB and TPMB. Materials and methods The inclusion criteria were as follows: PSA>2 ng/mL, and/or positive DRE, and/or suspicious lesion on TRUS and Pi-RADSv2.1≥3 score. In total, 102 patients were enrolled in the study. Biopsies were performed by two urologists. In a single procedure, the first urologist performed a FUS-TB and TPMB followed by second urologist who performed TRUS-GB and COG-GB. All specimens were obtained within a single procedure. Results The CsPCa detection rate and overall CDR per patient were comparable among the respective biopsy methods (p>0.05). Compared with other biopsy methods, a lower cisPCa was detected using COG-TB (p=0.004). The positive cores percentage ratio (p<0.001) as well as positive cores containing csPCa percentage ratio (p<0.001) significantly increased for the targeted biopsy methods. The median MCCL (p=0.52) as well the median for the MCCL of csPCa (p=0.47) did not differ significantly among the respective biopsy methods. Concordance of the Gleason scores between biopsy and post-prostatectomy pathology didn't differ significantly among biopsy methods (p=0.87). For TRUS-GB, FUS-TB and TPMB, the common predictive factors for csPCa were positive DRE, suspicious lesion on US and Pi-RADS 5. As for COG-TB, the only predictor was Pi-RADS 5. Conclusion The targeted methods did not show an increase in csPCa and overall CDR over systematic ones in patients with Pi-RADS≥3. A lower cisPCa was detected using COG-TB in comparison with the other methods. The sampling efficiency increased for the targeted biopsy methods which used only a proportion of positive cores and cores containing csPCa. There was no statistical difference in histology concordance among the biopsies. One common predictive factor of increased csPCa detection for all biopsy methods was Pi-RADS 5.