Is it worth carrying out ultrasound-magnetic resonance imaging fusion targeted biopsy on Prostate Imaging Reporting and Data System score 3 prostate lesions?

Objectives: To evaluate the use of ultrasound-magnetic resonance imaging fusion targeted biopsy for Prostate Imaging Reporting and Data System 3 prostate lesions.

Methods: We identified 227 patients with prostate-specific antigen levels ≥4 ng/mL who underwent concurrent transrectal ultrasound-guided systemic biopsy and fusion biopsy. Suspicious prostatic lesions were assessed in accordance with Prostate Imaging Reporting and Data System version 2.0. We compared ultrasound-magnetic resonance imaging fusion targeted biopsy and ultrasound-guided biopsy cancer detection rates in Prostate Imaging Reporting and Data System 3 lesions with those in other Prostate Imaging Reporting and Data System score lesions. In Prostate Imaging Reporting and Data System 3 patients, we identified clinically significant prostate cancer risk factors by logistic regression analysis.

Results: In total, 2770 transrectal ultrasound-guided and 867 fusion biopsy cores were obtained; where 332 (12.0%) and 194 (22.4%) cores were prostate cancer-positive, respectively (P < 0.001). The fusion biopsy cancer detection rate (8.0%) in Prostate Imaging Reporting and Data System 3 lesions was similar to that in Prostate Imaging Reporting and Data System 1-2 lesions, but was lower than that of Prostate Imaging Reporting and Data System 4 (30.0%; P < 0.001) and 5 lesions (65.2%; P < 0.001), and ultrasound-guided biopsy (12.0%; P = 0.023). For clinically significant prostate cancer detection, fusion biopsy in Prostate Imaging Reporting and Data System 3 lesions was inferior to that in Prostate Imaging Reporting and Data System 4 and 5 lesions, and non-superior to ultrasound-guided biopsy. Cancer detection rate trends were similar in biopsy-naïve patients. In Prostate Imaging Reporting and Data System 3 patients, prostate-specific antigen density was the only significant predictor of clinically significant prostate cancer.

Conclusions: The present findings do not support the use of ultrasound-magnetic resonance imaging fusion targeted biopsy for Prostate Imaging Reporting and Data System 3 lesions. Thus, we recommend the use of transrectal ultrasound-guided systemic biopsy for patients with Prostate Imaging Reporting and Data System 3 index lesions.