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MRI targeted TRUS guided fusion biopsy: Are systematic transrectal ultrasound biopsy still necessary now that we have targeting technology?
Michael Geffin, MD1, James Lin, MD2, Michael Curran, MD3.
1Greater Boston Urology, Framingham, MA, USA, 2Greater Boston Urology, Milton, MA, USA, 3Greater Boston Urology, Norwood, MA, USA.

MRI-targeted TRUS-guided fusion biopsy: Are systematic transrectal ultrasound biopsy still necessary now that we have targeting technology?
Introduction and Objectives
MRI imaging of prostate lesions have improved significantly in recent years. With computer aided drafting models we are now able to perform targeted biopsies of these lesions by overlaying MRI images on live ultrasound images. We assess whether adding systematic sampling to targeted biopsies increases our ability to diagnose prostate cancer.
Methods
This retrospective study of patient from a single large practice urology group who underwent MRI fused Ultrasound guided TRUS biopsy with no previous diagnosis of prostate between July 2015 and January 2016. All patients underwent multiparametric prostate MRI including T2 weighted, diffusion weighted, and dynamic contrast image sequencing. A single radiology group read all MRIs using PIRADs v2 to score lesions. To be included in this study each patient had the standard 12 core systematic biopsies and each targeted lesion must of had 1-2 cores
Results
There were 103 patient meeting inclusion criteria who underwent MRI fused Ultrasound guided TRUS biopsy with no previous diagnosis of prostate cancer between July 2015 and January 2016 (mean age 63.7 years, Average PSA 9.58 ng/ml, average ultrasound size 62 cm3). 85 patients had previous biopsies (PSA average 10.04 ng/ml, range 0.7-75.4). Percent of patients where cancer was not found, only in systematic biopsies, only targeted lesions or both systematic and target lesion in 44.6%, 14.5%, 14.5% and 55.3% respectively.
Conclusion
Prostate cancer is found independently in both targeted biopsies and systematic biopsies. In our series, if systematic biopsies were not performed then 26.8% of men with prostate cancers would have gone undiagnosed.


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