title: Diagnostic Accuracy of Transperineal MRI Fusion Biopsy in Comparison to Transrectal Biopsy with Regard to Incidental Histopathological Findings in Transurethral Resection of the Prostate.
abstract: OBJECTIVE
  To investigate the diagnostic accuracy of transperineal MRI/transrectal ultrasound (TRUS) fusion prostate biopsy vs. transrectal prostate biopsy in transurethral resection (TUR) specimen of men undergoing TUR of the prostate (TURP) for symptomatic bladder outlet obstruction.
  
  
  METHODS
  From a database of 3,509 men receiving prostate biopsy, all those undergoing TURP and negative prostate biopsy (n = 95; 45 transrectal, 50 transperineal fusion) were analysed. TURP specimens were compared with regard to incidental prostate cancer.
  
  
  RESULTS
  Pre- and peri-interventional parameters in transrectal vs. fusion biopsy groups for age (65.2 ± 7.8 vs. 65.5 ± 7.3 years; p = 0.84), prostate specific antigen (10.7 ± 8.5 vs. 10.9 ± 8.7 ng/mL; p = 0.93), preoperative prostate volume (72.5 ± 26.1 vs. 71.8 ± 28.1 mL; p = 0.91) and resected weight (43.7 ± 21.9 vs. 41.4 ± 20.7 g; p = 0.61) showed no significant differences. Analysing the TURP specimen, 5 incidental T1a prostate cancers were found (3 Gleason 3 + 3 = 6; 2 Gleason 3 + 4 = 7, all in the transrectal biopsy group). Although, more biopsy cores were obtained in the MRI/TRUS fusion biopsy group (26 cores [interquartile range, IQR 24-28] vs. 14 cores [IQR 12-24], p < 0.01), there was no statistical impact of the obtained number of cores (p = 0.9) on diagnostic accuracy. Statistical analyses revealed significantly better diagnostic accuracy favoring image-guided fusion biopsy (p = 0.02).
  
  
  CONCLUSIONS
  Our findings showed that a combination of MRI-targeted and systematic transperineal prostate biopsy improves patient safety. This is associated with a combination of transperineal biopsy technique and pre-interventional MRI.
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Svenja Christina
authors.initials: SC
authors.lastname: Dieffenbacher
authors.forename: Ionel Valentin
authors.initials: IV
authors.lastname: Popeneciu
authors.forename: Jan Philipp
authors.initials: JP
authors.lastname: Radtke
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
authors.forename: Boris Alexander
authors.initials: BA
authors.lastname: Hadaschik
authors.forename: Gencay
authors.initials: G
authors.lastname: Hatiboglu
mesh_terms: D000368:Aged; D016208:Databases, Factual; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D011470:Prostatic Hyperplasia / Q000150:complications / Q000473:pathology / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate; D018084:Ultrasonography, Interventional; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000473:pathology / Q000601:surgery*
keywords: Diagnostic accuracy; Prostate cancer; Transperineal MRI/transrectal ultrasound fusion biopsy; Transurethral resection of the prostate