The Value of Magnetic Resonance Imaging and Ultrasonography (MRI/US)-Fusion Biopsy in Clinically Significant Prostate Cancer Detection in Patients with biopsy-naïve men according to PSA levels: A propensity score matching analysis

Abstract Objectives To evaluate the detection rate of clinically significant prostate cancer (csPCa) in Magnetic resonance imaging and ultrasonography (MRI/US) fusion biopsy in patients with biopsy-naive men for varying prostate-specific antigen (PSA) levels. Since MRI can efficiently detect csPCa compared to standard transrectal ultrasound (TRUS) guided biopsy; however, the optimal PSA threshold for its use is unclear. Materials and Methods We retrospectively reviewed who underwent MRI/US-fusion and standard biopsy from January 2016 to June 2018. Patients were divided into 3 groups: PSA 10 ng/mL. Propensity scoring was performed to balance the characteristics of the different biopsy groups, and detection rate of csPCa was compared. Results Data from a total of 670 males were included in the analysis (standard TRUS, n=333; MRI/US fusion, n=337). Prior to matching, patients who received MRI/US-fusion biopsy had lower prostate volume. Propensity score matching balanced this characteristic and generated a cohort comprising 195 patients from each group. In the matched cohort, patients with PSA 4-10 ng/mL had a significantly increased risk of csPCa by MRI/US-fusion vs. standard biopsy (35.0% vs. 26.6%, p = 0.033). However, patients with PSA 10ng/mL had csPCa found by MRI/US-fusion vs. standard biopsy (78.0% vs. 80.0%), p = 0.596). In multivariate logistic analysis among patients with PSA 4-10 ng/mL, MRI/US-fusion biopsy (odds ratio: 2.46, 95% confidence interval = 1.31-4.60, p = 0.005) were significantly associated with a detection of csPCa. Conclusions Detection of csPCa by MRI/US-fusion biopsy is more efficient in patients with biopsy-naive men with PSA 4-10 ng/mL. However, standard TRUS biopsy may identify csPCa in patients with PSA