Addition of ultrasound and MRI fusion–targeted biopsy enhances systemic prostate biopsy

A study recently published in Radiology suggests that combined use of ultrasound and multiparametric MRI-targeted biopsy with systematic biopsy may be more effective for detecting clinically significant prostate cancers than using systematic biopsies alone.¹

For the prospective, randomized multicenter MULTIPROS study (NCT02745496), researchers assessed the use of multiparametric magnetic resonance imaging (MRI) in 582 men (mean age of 65) with suspected prostate cancer (PCa). The study authors also compared the combination of ultrasound and MRI fusion-targeted biopsies with systematic biopsy versus systematic biopsy alone for diagnostic accuracy in prostate cancer imaging.

For 89 men who had positive MRI findings and had a laparoscopic radical prostatectomy, the researchers found that multiparametric MRI successfully identified 131 out of 182 foci with clinically significant prostate cancer (csPCa). In addition to a sensitivity rate of 72%, multiparametric MRI had a 71% specificity rate and a positive predictive value (PPV) of 78%, according to the study. The researchers pointed out that MRI diagnosed 87% of cancers with a Gleason score (GS) greater than 7 and 54.4% of cancers with a GS of 7.

When comparing the combination of ultrasound and MRI-targeted biopsy along with systematic biopsy versus systematic biopsy alone, the study authors found the combination biopsy had a 12.7% higher detection of PCa (72.9% vs 60.2%) and 11.4% higher detection rate for csPCa (62.8% vs 51.4%). Targeted biopsy also offered improved detection of PI-RADS 5 (82% vs 76%) and PI-RADS 4 lesions (35% vs 28%) in comparison to systematic biopsy alone, according to the researchers.

“Although there is still debate regarding the optimal biopsy technique in men without biopsy and with lesions suspicious for cancer at MRI, combined systematic and targeted biopsies for PI-RADS 4 or 5 scores are superior to targeted or systematic biopsies alone in detecting csPCa,” wrote Ghulam Nabi, MD, a clinical professor in the Division of Imaging Science and Technology at the School of Medicine at the University of Dundee in Dundee, United Kingdom, and colleagues.

Reference

1. Wei C, Szewczyk-Bieda M, Bates AS, et al. Multicenter Randomized Trial Assessing MRI and Image-guided Biopsy for Suspected Prostate Cancer: The MULTIPROS Study. Radiology. 2023;308(1):e221428. doi: 10.1148/radiol.221428