title: Transperineal Versus Transrectal MRI/TRUS Fusion Targeted Biopsy: Detection Rate of Clinically Significant Prostate Cancer.
abstract: To evaluate the detection rate for clinically significant prostate cancer (PCa) of transperineal (TP) versus transrectal (TR) multiparametric (mp) magnetic resonance imaging (MRI)/transrectal ultrasound-guided (TRUS) fusion targeted biopsy.
  
  
  
  From January 2015 to January 2016, a total of 200 men (median age, 61 years) with negative digital rectal examination findings underwent repeat saturation TP prostate biopsy (SPBx; median 30 cores) for increasing or persistent elevated prostate-specific antigen values. Ten day before SPBx, all patients underwent 3.0 T pelvic mpMRI (Achieva 3T; Philips Healthcare Best, Netherlands). In the presence of mpMRI lesions suggestive of cancer (Prostate Imaging-Reporting and Data System [PI-RADS] score 4/5), targeted mpMRI/TRUS TR fusion guided biopsies (4 cores) and TP cognitive biopsies (4 cores) were added to SPBx.
  
  
  
  Median prostate-specific antigen was 8.6 ng/mL, and mpMRI revealed a suspicious lesion in 95 (47.5%) of 200 cases. Overall, in 60 (30%) of 200 men, a clinically significant PCa was found, and in all cases, mpMRI was positive. SPBx, TR fusion, and mpMRI/TRUS TP cognitive targeted biopsy diagnosed 59 (98.3%), 40 (78.3%), and 56 (93.3%) clinically significant PCa, respectively. TR fusion versus TP targeted biopsy missed 12 versus 1 (P = .001) cancers of the anterior zone and 8 versus 3 (P = .12) cancers of the peripheric gland, respectively; moreover, PCa diagnosed by TR fusion versus TP targeted biopsy had a mpMRI lesion diameter and percentage of positive cores equal to 13 versus 10 mm and 33% versus 58% (P = .001), respectively.
  
  
  
  mpMRI/TRUS TP cognitive targeted biopsy found a greater percentage of clinically significant PCa of the anterior zone compared to the mpMRI/TRUS TR fusion approach (93.3% vs. 25%; P = .0001).
authors.affiliation: Urology Unit, Cannizzaro Hospital, Catania, Italy. Electronic address: piepepe@hotmail.com.
authors.forename: Pietro
authors.initials: P
authors.lastname: Pepe
authors.affiliation: Imaging Department, Cannizzaro Hospital, Catania, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Garufi
authors.affiliation: Imaging Department, Cannizzaro Hospital, Catania, Italy.
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Priolo
authors.affiliation: Urology Unit, Cannizzaro Hospital, Catania, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Pennisi
mesh_terms: D000368:Aged; D051517:Digital Rectal Examination; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D007610:Kallikreins / Q000378:metabolism; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010502:Perineum; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology*; D012007:Rectum; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Cognitive MRI/TRUS transperineal biopsy; MRI/TRUS fusion prostate biopsy; MRI/TRUS fusion transrectal biopsy; MRI/TRUS targeted prostate biopsy; Prostate biopsy