PD41-06: Transperineal prostate biopsies using micro-ultrasound, MRI-guided and systematic biopsies (Madrid Protocol), an update with 482 patients

Moises Elias Socarras*, Javier Reinoso Elbers, Fabio Esposito, Isabella Greco, Julio Fernandez del Alamo, Vanesa Cuadros Rivera, Diego Carrion Monsalve, Juan Gomez Rivas, Luis Llanes Gonzalez, Luis Llanes Gonzalez, Fernando Gomez Sancha, Madrid, Spain

Introduction: Micro-Ultrasound (micro-US) is a novel high-resolution imaging technology that allows targeting prostate biopsies in real-time to areas of the prostate suspicious of cancer. We aimed to assess the diagnostic yield of combining biopsies targeted by micro-US and mpMRI as well as systematic biopsies (Madrid Protocol).

Methods: We analyzed 482 patients undergoing transperineal prostate biopsies using micro-US and mpMRI targeted and systematic biopsies. We used the Exact-Vu® micro-ultrasound system to perform the micro-US targeted biopsies and the BiopSee® fusion device with standard ultrasound resolution for performing mpMRI and systemic biopsies. We used the McNemar and ANOVA tests for the statistical analysis.

Results: Mean age was 63.46 ± 7.91 (58.15 - 63.75) years, prostate volume was 54.87 ± (34.75 - 69) g and PSA was 7.76 ± 6.35 (58.15 - 69.23) ng/mL respectively. The combination of targeted biopsies with micro-ultrasound + mpMRI + systematic biopsies offered an overall PCa detection rate of 58.92% and csPCa 43.77%, significantly higher than each of the other modalities alone.

Micro-US found 11 PCa missed by all other modalities. 9 of these were csPCa GG>1. Moreover, micro-US found 38 PCa missed by MRI and MRI TBx, 26/38 of them csPCa, as well as 21 patients missed by SBx, 16/21 of them csPCa. Therefore, the added value of micro-US beyond MRI TBx is 21.8% and beyond SBX is 8.43%. On the other hand, MRI TBx found 24 PCa lost by SBX, 16/24 of them csPCa and the combination of MRI TBx + SBX found 12 patients not detected by micro-US + SBX, 7/12 of them csPC GG>1.

Conclusions: The use of micro-US combined with mpMRI TBx and systematic biopsies has an excellent diagnostic yield and can be considered complementary, as each modality helps to detect cases missed by the other modalities.

Source of Funding: None