Role of region-of-interest magnetic resonance imaging fusion biopsy in mitigating overtreatment of localized prostate cancer - A retrospective cohort study

Background: Traditional ultrasonography-based prostate biopsy uses a transrectal approach for systematic sampling of 12 cores. The magnetic resonance imaging (MRI) fusion biopsy uses a targeted approach, first identifying regions of interest (ROI) clinically suspicious for prostate cancer (PCa) through MRI, before performing a prostate biopsy aided by ultrasonography. Methods: The single-center institutional retrospective cohort study used 442 men who were recommended for localized PCa management. Cohort A (n = 346) comprised patients who underwent MRI-guided TRUS biopsies, which included both standard 12-core TRUS biopsies and MRI-targeted biopsies performed simultaneously. Cohort B (n = 96) comprised patients who received only standard TRUS biopsy. The primary endpoint was Gleason reclassification, defined as the change in Gleason scores between standard TRUS and targeted region-ofinterest (ROI) biopsies among cohort A. Secondary endpoint assessed the role of ROI biopsies in mitigating overtreatment by analyzing the probability of undergoing treatment and the duration of active surveillance (AS). Results: Among men classified as no tumor on standard biopsy, 16.9 % showed Gleason disease on subsequent ROI biopsy. Additionally, ROI group also had a longer time to receive primary treatment (P = .017), as they were more likely to opt for AS (54 %). Lastly, median time spent on AS was longer for the ROI group compared with the non-ROI cohort (P = .002). Conclusion: Adding multiparametric MRI (mpMRI) biopsy to standard TRUS biopsy may increase the detection of PCa. Additionally, mpMRI may allow patients to remain safely on AS, thereby reducing the need of prostate biopsies and improving cost-effectiveness.