Prostate cancer clinic presentation varies greatly, ranging from indolent cancer to aggressive metastatic-potential disease, with the range defined in categories ranging from very low-risk to very high-risk disease. A classic transrectal ultrasound (TRUS) biopsy is a standard method used to diagnose prostate cancer. The main disadvantage of TRUS-guided biopsies is that they miss a substantial proportion of significant PCa (approximately 20%) because of sampling errors, especially in the anterior part of the prostate gland. On the other hand, a high proportion of men are diagnosed with clinically insignificant diseases, which may result in subsequent overtreatment. Multiparametric magnetic resonance imaging/transrectal ultrasound fusion-guided prostate biopsy combines the MRI images and precontoured suspicious lesions with real-time transrectal ultrasound scanning.
From July 2019 until September 2022, prostate biopsies were performed on 167 patients of the Urology Clinic at St. Marina University Hospital in Varna. For that objective, a Bk5000 ultrasound system with Predictive Fusion software was used, allowing for the visualization and biopsy of suspicious MRI lesions in real time under ultrasound control. Benign prostatic hyperplasia was found in 87 of the patients (52% of all patients). In 79 of the patients (47% of all patients), the result was adenocarcinoma. The frequency of patients with prostate carcinoma increases with higher PI-RADS suspicious lesions, with prostate carcinoma being histologically proven in only 6% of PI-RADS 2 patients and in 96% of PI-RADS 5 patients. There had also been a correlation discovered between PI-RADS and ISUP histological grade. ISUP 4 and ISUP 5 histological results were seen almost entirely in patients with PI-RADS 4 and PI-RADS 5 zones. The correlation between a high PI-RADS score of detected lesions and histologically confirmed clinically significant prostate carcinoma demonstrates a high diagnostic value. The method is appropriate for both re-biopsy examinations following previous negative systemic biopsies and for an initial prostate biopsy. This modern practice can be successfully applied not only to diagnose the condition but also to differentiate a significant cancer from one that is indolent in order to maximize the benefit of definitive treatment and minimize any complications that overtreatment may provoke.
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