title: Comparison of free-hand transperineal mpMRI/TRUS fusion-guided biopsy with transperineal 12-core systematic biopsy for the diagnosis of prostate cancer: a single-center prospective study in China.
abstract: OBJECTIVE
  To prospectively compare biopsy outcomes between free-hand transperineal mpMRI/TRUS fusion targeted biopsy (TB) and transperineal systematic biopsy (SB) in patients with first prostate biopsy.
  
  
  METHODS
  In all, 224 consecutive patients with the suspicion of PCa were investigated. All patients were evaluated by 3.0-T mpMRI applying the ESUR criteria. All patients underwent free-hand transperineal mpMRI/TRUS fusion TB and additionally a transperineal SB. Pathological findings of TB, SB, and step-sectioned RP specimens were analyzed.
  
  
  RESULTS
  The median age of the patients was 69 (40-85) years, median PSA level was 10.05 (3.61-78.39) ng/mL, and median prostate volume was 45.5 (22-77) mL. Overall, the PCa detection rate was 50.45% (113/224). TB detected significantly more cancer [44.2% (99/224) vs. 34.8% (78/224); P = 0.001] and clinically significant PCa [75.75% (75/99) vs. 62.82% (49/78); P = 0.005] than SB. For the upgrading of Gleason score, 39.74% (31/78), more clinically significant PCa was detected by using additional TB than by SB alone. Conversely, 5.05% (5/99) more clinically significant PCa was found by SB in addition to that by TB. The location of 96.67% (58/60) and Gleason score of 60% (36/60) of TB-proven ITs were correctly identified, as corroborated by RP specimens. The median IT volume was 1.125 (0.21-19.87) ml on MRI and 1.41 (0.13-9.56) ml in RP specimens.
  
  
  CONCLUSIONS
  Free-hand transperineal mpMRI/TRUS fusion biopsy was associated with a higher detection rate of clinically significant PCa while taking fewer cores. Moreover, this technique can reliably predict the location, and relatively reliably predict cancer volume and Gleason score of ITs.
authors.affiliation: Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China.
authors.forename: Jong
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Pathology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Fu
authors.affiliation: Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, People's Republic of China.
authors.forename: Danyan
authors.initials: D
authors.lastname: Li
authors.affiliation: School of Public Health, Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China.
authors.forename: Suhan
authors.initials: S
authors.lastname: Guo
authors.affiliation: Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China.
authors.forename: Shengjie
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China.
authors.forename: Haifeng
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Urology, The Affiliated Yixing People's Hospital of Jiangsu University, Yixing, 214200, Jiangsu, People's Republic of China.
authors.forename: Xuping
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Department of Urology, The Affiliated Yixing People's Hospital of Jiangsu University, Yixing, 214200, Jiangsu, People's Republic of China.
authors.forename: Weimin
authors.initials: W
authors.lastname: Zhou
authors.affiliation: Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China. dr.ghq@nju.edu.cn.
authors.forename: Hongqian
authors.initials: H
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009929:Organ Size; D010537:Peritoneum; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D012007:Rectum
chemical_list: D017430:Prostate-Specific Antigen
keywords: Index tumor; Location; Prostate cancer; Targeted biopsy; mpMRI/TRUS fusion