A comparative study of diagnostic accuracy for prostate cancer detection between blind transrectal biopsy versus multiparametric mri image based trus biopsy

Author: 
Govindarajan.R., Matheen Jaffer Farman.R and Sanjeev Kumar

Introduction: Prostate cancer (PCa) is one of the most commonly diagnosed cancer in males .The diagnosis of carcinoma prostate cancer remains one of the only blind biopsy procedures done for cancer detection. Although the blind, finger guided transrectal biopsy has been replaced by TRUS-guided biopsy, in developing countries like India, blind biopsies are still being employed. Of late. Multi parametric MRI guided TRUS biopsies and mpMRI fusion biopsy are currently being employed in many of the centres for accurate diagnosis of prostate cancer. The objective of my study is to study and compare the diagnostic accuracy for prostate cancer detection by blind transrectal biopsy and Multiparametric MRI Image based TRUS biopsy MRI Image based TRUS biopsy.
Materials And Methods: Patients attending Urology outpatient department at Govt. Kilpauk Medical College Hospital and Govt. Royapettah Hospital, Age group of 40 to 80 years
With either hard, nodular prostate on digital rectal examination (DRE) or with a serum PSA value more than 4ng/ml from January 2015 to February 2016. All the eligible patients were subjected to 1.5 Tesla Multiparametric MRI. After adequate bowel preparation and antibiotic prophylaxis, blind, finger guided transrectal biopsy (12cores) was done by urologist. This was followed by TRUS biopsy based on the MRI images
Results: In this study, about 40 patients who fulfilled the inclusion criteria were included in the study. All 40 patients underwent both blind finger guided transrectal biopsy and mpMRI image based TRUS biopsy. Out of the 40 patients, only 9 (22%) patients who underwent blind finger guided transrectal biopsy were found to be cancer positive on histopathological examination. In comparison, 22 (55%) patients who underwent mpMRI image based TRUS biopsy were found to be cancer positive on HPE. 12 of the patients who had negative biopsy report with the blind finger guided method were found to be cancer positive on mpMRI image based TRUS biopsy
Conclusion: The overall value of MRI guided TRUS biopsy method in detecting prostatic carcinoma as a combined screening and case-finding test is very good.More chance of missing the cancerous lesion (false negative) by blind transrectal method Significant upgrading of Gleason Score in mpMRI based TRUS biopsy in comparison to the other.

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