Incidence of prostate cancer in MRI-TRUS fusion biopsy patients with a previous negative TRUS biopsy in Girona

Abstract

Background. Prostate cancer is the second most common solid cancer in men worldwide. It is estimated that one out of nine men will suffer from it through their life span. This disease is the most deadly for men between 45 and 60 years old in the Western countries. Hence, it is essential to find competent diagnostic tools to detect the disease on early stages and treat it. At present, the most common procedure for diagnosis is a combination of medical history, physical examination, and tests, such as the prostate-specific antigen (PSA) test, digital rectal examination, and prostate biopsy. These techniques might fail to detect 50% to 80% of the tumours and also might detect nonclinically significant cancers that would not cause any harm to the patient (causing over-diagnosis and over-treatment). Nowadays, there are new techniques to guide the biopsy and improve the diagnosis. The use a previous multi-parametric magnetic resonance imaging (MRI) (where the suspicious areas are located and graded by the radiologist) and its fusion with real images from the transrectal probe might assist to target the suspicious area and improve the detection rate for prostate cancer. Objectives. The main goal for this study is to evaluate the incidence of prostate cancer in men with a second targeted biopsy using the MRI-Ultrasound fusion software imaging. A secondary objective is to know the incidence of clinically significant prostate cancer in these population. Design and Methods. The study will be conducted as a cross-sectional, retrospective, descriptive, and observational analysis at the Hospital Universitari Dr. Josep Trueta in Girona over a period of four years. The study will involve 93 participants at least. The study will focus on participants who had previously undergone a transrectal ultrasound-guided biopsy (standard procedure nowadays) that resulted in a negative diagnosis for prostate cancer. A second biopsy will be performed guided by multi parametric MRI images and Trans-rectal Ultrasound imaging to locate the suspicious areas and obtain the cores (targetted biopsy). These participants will be examined retrospectively (the results of the second biopsy as well as their risk factors) to assess whether the subsequent MRI-ultrasound-fusion guided biopsy provided a more efficient and accurate diagnosis. Population. Men between 45-80 years old currently under study for prostate cancer at Hospital Universitari Doctor Jospe Trueta. The first prostate biopsy, which was systemic and targeted, and guided by Ultrasounds, was negative. The PSA blood levels remain high or are increasing. An MRI was performed and showed a Prostate Imaging Reporting and Data System (PIRADS) ≥ 3. A second biopsy is performed with the imaging technique MRI - ultrasound fusion- guided