Introduction: Anterior prostate cancers are frequently missed since they can be neither palpable nor tangible on physical examination. The objective of this study was to analyze the MRI/transrectal ultrasound-fusion biopsies to detect and to characterize significant prostate cancer in the anterior fibromuscular stroma (AFS) and in the transition zone of the prostate.
Methods: One hundred and fourteen patients underwent prebiopsy 3 T multi parametric (mp) MRI and transperineal biopsy between February 2019 and May 2021. MRI images were analyzed using PIRADS (Prostate Imaging-Reporting and Data System) ver 2. All patients had systematic biopsies and targeted biopsies with rigid software registration in case of MRI-suspicious lesions.
Results: The positive rates of systematic and targeted biopsies were 10% and 29%, respectively with a significant difference. The cancer occupancy rate of the biopsy specimens was higher in the targeted biopsy, 22.2% and 36.3%, respectively. There were AFS tumors in 23 of 114 patients, and they harbored 23 lesions (10%) in AFS on mpMRI. The positive rate of targeted biopsy by PI-RADs category was 77% for PI-RADs 5, 42% for PI-RADs 4, and 16% for PI-RADs 3. The positive rate by target region were 24%, 31%, and 83% for peripheral zone (PZ), transition zone (TZ), and AFS, respectively. Especially, in PIRADs category 3 region, the positive rate in AFS region was a high positivity rate of 100%.
Conclusions: Targeted biopsy has improved cancer detection rates. However, we should also pay attention to lesions of low PIRADs category in the AFS region.
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