Abstract:

Objective

To explore the diagnostic efficacy of transperineal cognitive-fusion targeted biopsy for prostate cancer （PCa） in patients with the prostate imaging reporting and data system（version 2.1） （PI-RADS V2.1） score of 5.

Methods

The clinical data of patients who underwent prostate biopsy in the Department of Urology，the Second Affiliated Hospital of Nantong University from January 2018 to July 2022 were retrospectively analyzed.All patients were biopsy naive，and only patients with PI-RADS V2.1 score of 5 undergoing combined biopsy （cognitive-fusion targeted biopsy combined with systematic biopsy） were included in the final analysis.The detection rate of prostate cancer and clinically significant prostate cancer （csPCa） were compared among the 3 biopsy approaches （cognitive-fusion targeted biopsy，systematic biopsy，and the combined biopsy）.In addition，the detection rate of PCa and csPCa of the 3 biopsy approaches were further analyzed according to different total prostate specific antigen （tPSA） and prostate volume （PV） intervals.The operation time of the 3 biopsy approaches were also compared.As some suspicious lesions located in unilateral lobe of prostate，the complementary value of systematic biopsy were analyzed for the pathological results.

Results

176 patients who underwent combined biopsy were included.In 176 patients，the detection rate of PCa and csPCa by cognitivefusion targeted biopsy，systematic biopsy and combined biopsy was comparable （89.2% vs 88.1% vs 89.8%，84.7% vs 79.5% vs 85.8%），with no significant difference （all P＞ 0.05）.In different tPSA intervals（＜4 ng/ml，4≤tPSA≤10 ng/ml，10＜tPSA≤20 ng/ml，20＜tPSA≤100 ng/ml，＞100 ng/ml） and PV intervals（≤30 ml，30-60 ml，＞60 ml），the detection rate of PCa and csPCa by the above 3 biopsy approaches were similar，with no significant difference （all P＞0.05）.The mean operation time of cognitive-fusion targeted biopsy was significantly lower than that of systematic biopsy and combined biopsy （all P＜0.001）.113 patients had suspicious lesions located in unilateral lobe of prostate，and 95（84.1%） of them were diagnosed as PCa by cognitive-fusion targeted biopsy.However，the results of systemic biopsy revealed that 68（71.6%） patients were positive in the contralateral lobe of prostate.

Conclusions

In patients with PI-RADS V2.1 score of 5，performing cognitive-fusion targeted biopsy and omitting systematic biopsy does not decrease the detection of PCa and csPCa，but may miss the pathological information of the contralateral lobe when suspicious lesions located in the unilateral lobe of prostate，affecting the following treatment strategy.

Key words: Prostate cancer, Cognitive-fusion targeted biopsy, Prostate imaging report and data system, Systematic biopsy, Combined biopsy