Validation of new TRUS biopsy techniques for PI-RADS 4 or 5

Purpose: Recently, new magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) techniques and imaging features of Prostate Imaging and Report and Data System (PI-RADS) 4 or 5 have been reported. The aim of this study was to validate the outcomes of new TRUS-guided biopsy techniques for cancer detection in patients with PI-RADS 4 or 5. Methods: Between June 2018 and November 2018, 94 men underwent TRUS-guided biopsy after PI-RADS 4 (n = 59) or 5 (n = 35) was categorized as an index lesion on MRI. For PI-RADS 4 group, target biopsy was performed in 5 and combination biopsy (target and systematic biopsies) was in 54. For PI-RADS 5 group, target biopsy was performed in 19 and combination biopsy was in 16. Target to combination biopsy ratios and significant cancer detection rates (CDRs) were compared between the groups. Significant cancer was defined as a Gleason score >= 7 tumor. Standard reference was biopsy examination. Fisher's exact were used for statistical analysis. Results: Target to combination biopsy ratios was 5:54 in the PI-RADS 4 group and 19:16 in the PI-RADS 5 group (P<0.0001). The significant CDR of the target biopsy were 42.4% (25/59) in the PI-RADS 4 group and 82.6% (29/35) in the PI-RADS 5 group (P=0.0002). The significant CDR of combination biopsy was 44.1% (26/59) in the PI-RADS 4 group and 85.7% (30/35) in the PI-RADS 5 group (P<0.0001). Conclusion: New TRUS biopsy techniques provides high significant CDR patients with PI-RADS 4 or 5. Therefore, TRUS should be performed prior to fusion or in-bore biopsy to determine if these categories are visible.