Modern Diagnosis of Prostate Cancer Using Fusion Biopsy: Results of a Prospective Cohort Study

Prostate cancer (PCa) is one of the most common oncological diseases in men. Standard prostate biopsy with subsequent histological verification is now an integral part of the diagnosis of PCa, but the number of false-negative results and cases of underestimation of the degree of tumor aggressiveness remain excessively high. Advances in multiparametric magnetic resonance imaging have led to improved detection of prostate tumors. Fusion of magnetic resonance imaging data with transrectal ultrasound allows for targeted biopsy of suspicious lesions. The objective: to improve the diagnostic value of fusion-guided prostate biopsy based on the results of a comparative analysis of peripheral blood parameters and medical imaging methods. Materials and methods. The results of fusion biopsy performed at the SI “Academician O. F. Vozianov Institute of Urology of NAMS of Ukraine” in 101 patients with suspected PCa were analyzed. The average age of the patients was 62.8 ± 7.4 years. To assess the effectiveness of fusion biopsy, the following indicators were determined: blood test for total prostate-specific antigen (ng/ml); prostate volume according to magnetic resonance imaging (cm3); prostate-specific antigen density (ng/ml/cm3); localization of the lesion according to magnetic resonance imaging; size of the lesion; sensitivity and specificity of magnetic resonance imaging in detecting PCa. Results. The main factors that increase the detection of PCa by fusion biopsy are: total blood prostate-specific antigen ≥ 9.44 ng/ml (p = 0.017), prostate-specific antigen density ≥ 0.16 ng/ml/cm3 (p = 0.03), size of the pathological lesion in the prostate ≥ 9.31 mm (p = 0.025) and location of the lesion in the peripheral area of the prostate (p = 0.006). Factors that do not affect the detection of PCa by fusion biopsy: prostate volume and localization of the lesion in the transitional area of the prostate. Conclusions. To improve the detection of clinically significant PCa and reduce overdiagnosis of low-risk PCa, targeted fusion biopsy is advisable.