A comparison of cancer detection rates between template systematic biopsies obtained using MRI-US fusion machine and freehand transrectal ultrasound-guided systematic biopsies.

INTRODUCTION There are reports that the 12-core template systematic biopsies (SBx) obtained using software registration machines (e.g. Artemis) have higher cancer detection rates (CDRs) of prostate cancer (PCa) than the standard, freehand 12-core transrectal ultrasound (TRUS) guided biopsies. The goal of our study is to compare the clinically significant (CS) CDRs of SBx in two independent cohorts who underwent freehand TRUS-SBx alone (Cohort A) or machine-guided SBx as part of a combined MRI-US fusion biopsy (FBx) (Cohort B). MATERIALS AND METHODS A retrospective review of all patients undergoing prostate biopsies over a 4-year period at the University of Cincinnati Medical Center was performed. CS cancer was defined as having a Gleason score ≥ 7. MRI-US FBx were obtained using an Artemis software registration device (ARTEMIS™, Eigen Inc., Grass Valley, CA). Statistical significance was considered at p < 0.05. RESULTS Nine hundred and thirty men underwent SBx (Cohort A: 474, Cohort B: 456). There were no statistical differences between cohort A and B in CS CDRs in the overall population (39.3% vs 33.8%; p=0.093), biopsy naïve patients (40.4% vs 39.8%; p=0.951) or patients with a prior negative biopsy (22.7% vs 25.0%; p=0.910). Multivariate logistic regression controlling for age, race, prostate-specific antigen level, prostate volume, abnormal digital rectal exam, and family history of PCa demonstrated comparable CS CDRs, which was maintained when further stratified by prior biopsy history (all patients: OR 0.99, 95% CI 0.71-1.38, p=0.958; biopsy naïve: OR 0.79, 95% CI 0.51-1.22, p=0.291; prior negative biopsy: OR 0.64, 95% CI 0.21-1.75, p=0.403). CONCLUSIONS Our study did not find a significant difference in the CS CDRs of machine-guided SBx compared to the freehand TRUS-SBx. Unless the SBx is done at the time of FBx, use of these machines for obtaining SBx only is unlikely to result in any increase of CS CDRs.