Comparison between target magnetic resonance imaging (MRI) in‐gantry and cognitively directed transperineal or transrectal‐guided prostate biopsies for Prostate Imaging–Reporting and Data System (PI‐RADS) 3–5 MRI lesions

Objective To compare the detection rates of prostate cancer ( PC a) in men with Prostate Imaging–Reporting and Data System ( PI ‐ RADS ) 3–5 abnormalities on 3‐Tesla multiparametric (mp) magnetic resonance imaging ( MRI ) using in‐bore MRI ‐guided biopsy compared with cognitively directed transperineal ( cTP ) biopsy and transrectal ultrasonography ( cTRUS ) biopsy. Methods This was a retrospective single‐centre study of consecutive men attending the private practice clinic of an experienced urologist performing MRI ‐guided biopsy and an experienced urologist performing cTP and cTRUS biopsy techniques for PI ‐ RADS 3–5 lesions identified on 3‐Tesla mpMRI. Results There were 595 target mp MRI lesions from 482 men with PI ‐ RADS 3–5 regions of interest during 483 episodes of biopsy. The abnormal mp MRI target lesion was biopsied using the MRI ‐guided method for 298 biopsies, the cTP method for 248 biopsies and the cTRUS method for 49 biopsies. There were no significant differences in PC a detection among the three biopsy methods in PI ‐ RADS 3 (48.9%, 40.0% and 44.4%, respectively), PI ‐ RADS 4 (73.2%, 81.0% and 85.0%, respectively) or PI ‐ RADS 5 (95.2, 92.0% and 95.0%, respectively) lesions, and there was no significant difference in detection of significant PC a among the biopsy methods in PI ‐ RADS 3 (42.2%, 30.0% and 33.3%, respectively), PI ‐ RADS 4 (66.8%, 66.0% and 80.0%, respectively) or PI ‐ RADS 5 (90.5%, 89.8% and 90.0%, respectively) lesions. There were also no differences in PC a or significant PC a detection based on lesion location or size among the methods. Conclusion We found no significant difference in the ability to detect PC a or significant PC a using targeted MRI ‐guided, cTP or cTRUS biopsy methods. Identification of an abnormal area on mp MRI appears to be more important in increasing the detection of PC a than the technique used to biopsy an MRI abnormality.