With the widespread adoption of multiparametric MRI (mpMRI) for investigation of suspected prostate cancer, targeted biopsy specimens are more common practice than previously held. The PRECISION trial demonstrated a reduced detection of insignificant cancer whilst increasing the detection of significant cancers when patients only with positive MRIs were biopsied. Whilst the PROMIS study demonstrated 11% of normal MRI, had biopsy confirmed prostate cancer. This study aims to investigate the accuracy and sensitivity of targeted trans-rectal ultrasound (TRUS) prostate biopsies when correlated with MRI.

A prospective database was maintained for the cohort of patients who underwent TRUS procedures with prior mpMRI by a single surgeon. The MRI findings were compared to the subsequent histopathological results from the targeted biopsies.

A total of 91 men were included in the study, with a mean age of 67 years and mean PSA of 9.2 ng/ml. 75% had Prostate Imaging and Reporting Data System (PI-RADS) 4-5 lesions 24% had PI-RADS 3 lesions. Clinically significant prostate cancer was identified in 73% target biopsies. 12% had ISUP 5, 10% ISUP 4, 10% ISUP 3 and 41% ISUP 2 disease. 27% of targeted biopsies had a ‘negative’ result, either no malignancy or clinically insignificant (ISUP 1) disease. An ISUP grade of higher significance was identified outside of the target biopsy in 14% patients. The upstaging from a negative targeted biopsy to significant cancer was identified in 8% patients. Targeted TRUS biopsy had a sensitivity of 92% and a negative predictive value of 71%

In the dynamic landscape of prostate cancer diagnosis, the integration of mpMRI and targeted TRUS prostate biopsies accurately identifies significant prostate cancer. This study demonstrates target only biopsy is highly sensitive and has a high negative predictive value. Data collection is ongoing and we will have 4 years of data completed.