Magnetic resonance imaging-guided targeted prostate biopsy: Comparison between computer-software-based fusion versus cognitive fusion technique in biopsy-naïve patients.

OBJECTIVE: To compare magnetic resonance imaging-guided cognitive fusion-targeted biopsies versus computer-software-based fusion-targeted biopsies in prostate biopsy-naïve patients. METHODS: This was a retrospective review of 298 consecutive patients, in which suspected clinically significant prostate cancer lesions were detected on pre-biopsy magnetic resonance imaging, and cognitive fusion-targeted biopsies or software-guided magnetic resonance imaging-ultrasound fusion-targeted biopsies was carried out. The positivity rates of any cancer and clinically significant prostate cancer, Gleason score, and maximum cancer core length were compared between the cognitive fusion-targeted biopsies and software-guided magnetic resonance imaging-ultrasound fusion-targeted biopsies groups. RESULTS: The any-cancer positivity rate was 79.6% (90/113 patients) in the cognitive fusion-targeted biopsies group and 84.8% (157/185 patients) in the software-guided magnetic resonance imaging-ultrasound fusion-targeted biopsies group (P = 0.516), and the clinically significant prostate cancer positivity rate was 72.5% (82/113 patients) in the cognitive fusion-targeted biopsies group and 75.7% (140/185 patients) in the software-guided magnetic resonance imaging-ultrasound fusion-targeted biopsies group (P = 0.498). Among the patients in which the largest lesion diameter on magnetic resonance imaging was ≤5.0 mm, the clinically significant prostate cancer positivity rate was 39.2% (11/28 patients) in the cognitive fusion-targeted biopsies group and 66.6% (24/36 patients) in the software-guided magnetic resonance imaging-ultrasound fusion-targeted biopsies group (P = 0.043). The median maximum cancer core length was 7.5 mm (0.25-16 mm) in the cognitive fusion-targeted biopsies group and 8 mm (0.2-19 mm) in the software-guided magnetic resonance imaging-ultrasound fusion-targeted biopsies group (P = 0.040). CONCLUSIONS: Software-guided magnetic resonance imaging-ultrasound fusion-targeted biopsies offers a greater detection rate for smaller targeted lesions and also superior ability to sample greater cancer core length compared with cognitive fusion-targeted biopsies. The present results suggest that software-guided magnetic resonance imaging-ultrasound fusion-targeted biopsies might improve biopsy outcomes compared with cognitive fusion-targeted biopsies.