The following is a summary of “Assessment of the accuracy of biparametric MRI/TRUS fusion-guided biopsy for index tumor evaluation using postoperative pathology specimens,” published in the April 2024 issue of Urology by Shimizu et al.

Multiparametric MRI (mpMRI) is a cornerstone in the diagnostic landscape for prostate cancer, offering valuable insights for diagnosis, surveillance, and staging. However, its widespread adoption is impeded by various drawbacks, including elevated costs, prolonged examination durations, and the necessity of gadolinium-based contrast agents. This study endeavors to explore the precision of preoperatively assessed index tumors (ITs) utilizing biparametric MRI (bpMRI)/transrectal ultrasound (TRUS) fusion biopsy in comparison with radical prostatectomy (RP) specimens.

Incorporating a cohort of 113 patients diagnosed with prostate cancer via bpMRI/TRUS fusion-guided biopsies of lesions categorized as Prostate Imaging Reporting and Data System (PI-RADS) ≥ 3, researchers followed their journey through robot-assisted laparoscopic radical prostatectomy (RARP) at the institution from July 2017 to March 2023. The investigation delved into the alignment between preoperative and postoperative IT localization, the highest Gleason score (GS), and tumor diameter across these patients.

The findings of the study revealed that the preoperative clinical T (cT) stage corresponded with the postoperative pathological T (pT) stage in 53 cases (47%), with 31 cases (27%) experiencing upstaging and 29 cases (26%) demonstrating downstaging (Weighted Kappa = 0.21). Preoperative and postoperative IT localizations demonstrated congruency in 97 cases (86%). Moreover, the concordance rate between Gleason groups in targeted biopsies and RP specimens stood at 51%, with 25 cases (23%) witnessing an upgrade and 27 cases (25%) experiencing a downgrade (Weighted Kappa = 0.42). 

Notably, the maximum diameter of the IT and the maximum cancer core length on biopsy significantly correlated with the RP tumor’s maximum diameter (p < 0.001 for both).

In conclusion, the diagnostic accuracy of bpMRI/TRUS fusion biopsy mirrors that of mpMRI, hinting at its potential as a cost-effective and time-efficient alternative in the clinical landscape.

Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01473-0