Detection of prostate cancer using magnetic resonance imaging/ultrasonography image‐fusion targeted biopsy in African‐American men

Objective To assess the diagnostic yield of targeted prostate biopsy in African‐American (A‐A) men using image fusion of multi‐parametric magnetic resonance imaging (mp MRI ) with real‐time transrectal ultrasonography ( US ). Patients and Methods We retrospectively analysed 661 patients (117 A‐A and 544 Caucasian) who had mp MRI before biopsy and then underwent MRI / US image‐fusion targeted biopsy ( FTB ) between October 2012 and August 2015. The mp MRI s were reported on a 5‐point Likert scale of suspicion. Clinically significant prostate cancer ( CSPC ) was defined as biopsy Gleason score ≥7. Results After controlling for age, prostate‐specific antigen level and prostate volume, there were no significant differences between A‐A and Caucasian men in the detection rate of overall cancer (35.0% vs 34.2%, P = 0.9) and CSPC (18.8% vs 21.7%, P = 0.3) with MRI / US FTB . There were no significant differences between the races in the location of dominant lesions on mp MRI , and in the proportion of 5‐point Likert scoring. In A‐A men, MRI / US FTB from the grade 4–5 lesions outperformed random biopsy in the detection rate of overall cancer (70.6% vs 37.2%, P = 0.003) and CSPC (52.9% vs 12.4%, P < 0.001). MRI / US FTB outperformed random biopsy in cancer core length (5.0 vs 2.4 mm, P = 0.001), in cancer rate per core (24.9% vs 6.8%, P < 0.001), and in efficiency for detecting one patient with CSPC (mean number of cores needed 13.3 vs 81.9, P < 0.001), respectively. Conclusions Our key finding confirms a lack of racial difference in the detection rate of overall prostate cancers and CSPC with MRI / US FTB between A‐A and Caucasian men. MRI / US FTB detected more CSPC using fewer cores compared with random biopsy.