MP58-08: TransPERINEAL vs transRECTAL MRI/TRUS fusion prostate biopsy: a matched-pair comparison

Masatomo Kaneko*, Luis Medina, Amir Lebastchi, Giovanni Cacciamani, Alireza Ghoreifi, Marina Lenon, Reid Senesac, Manju Aron, Vinay Duddalwar, Suzanne Palmer, Inderbir Gill, Andre Abreu, Los Angeles, CA

Introduction: To compare transPERINEAL (TP) versus transRECTAL (TR) magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion prostate biopsy (fPBx) in men with suspicion of prostate cancer (PCa).

Methods: From a prospectively maintained PBx database (IRB# HS-13-00663), we identified consecutive men who underwent TP or TR PBx from January 2016 to September 2021. Inclusion criteria: I) multiparametric MRI (T2W, DWI, ADC, DCE) within 6M prior to biopsy; II) PCa treatment-naïve; III) No prior surgery for BPH; IV) No saturation biopsy. All patients underwent MRI followed by 12-14 core systematic biopsy. Men with Prostate Imaging-Reporting and Data System (PIRADS) scores 3-5 underwent, at minimum two additional target biopsy (TB) cores per suspicious lesion. TP and TR MRI/TRUS fPBx were performed by “free-hands” technique (no grid template or needle-guide for TP fPBx) using an organ-based tracking imaging fusion system (Trinity–Koelis) by a single operator. MRIs were interpreted by an experienced radiologist. Specimens were evaluated by uropathologists according to the International Society of Urological Pathology guidelines. Men who underwent TP PBx were matched 1:2 with a synchronous cohort undergoing TR PBx by the following parameters: PSA, Prostate volume (PV) and PIRADS score. Clinically significant PCa (CSPCa) defined as Grade Group=2. Uni- and multivariable analyses were performed. Statistical significance defined as p<0.05.

Results: Overall, 504 patients met inclusion criteria: 168 TP PBx were pair-matched to 336 TR PBx patients. Median age was 67 vs 66yrs, p=0.28; PSA 7.46 vs 7.19ng/mL, p=0.88; PV 56 vs 52cc, p=0.51; PIRADS 1-2 (29% vs 29%), PIRADS 3 (21% vs 21%), PIRADS 4 (28% vs 31%) and PIRADS 5 (23% vs 19%), p=0.80; lesion size on MRI 13 vs 13mm, p=0.31; and number of MRI lesions (1 vs 1), p=0.23; were similar between TP vs TR PBx at baseline, respectively. For PIRADS 1-2, PCa (39% vs 27%; p=0.13) and CSPCa (2% vs 6%; p=0.43) detection were similar for TP and TR PBx, respectively. For PIRADS 3-5 lesions, PCa (72% vs 78%; p=0.19) and CSPCa (59% vs 60%; p=0.91) detection were similar for TP vs TR fPBx, respectively. The median maximum PCa TB core length (11 vs 9mm; p=0.028) and percent (80% vs 65%; p<0.01) were higher for TP vs TR fPBx. Independent predictors for CSPCa detection were age, PSA, PV, suspicious digital rectal examination, number of MRI lesions, PIRADS 3-5 and number of TB cores taken.

Conclusions: Free-hands transPERINEAL MRI/TRUS fusion PBx provides similar PCa and CSPCa, with larger PCa core length and percent than transRECTAL PBx.

Source of Funding: None.