Comparison of MRI/US Fusion Targeted Biopsy and Systematic Biopsy in Biopsy-Naive Prostate Patients with Elevated Prostate-Specific Antigen: A Diagnostic Study

Purpose: This study aimed to compare the detection rate of prostate cancer (PCa) between targeted biopsy and systematic biopsy. Patients and Methods: A total of 671 patients who underwent both targeted biopsy and systematic biopsy were included in this study. The stratified analysis was conducted based on Prostate Imaging Reporting and Data System (PIRADS) scores, region of interest load (ROI-load). Results: There was no statistical difference in the detection rate of PCa patients between systematic biopsy and targeted biopsy (44.41% vs 45.6%, P>0.05), while the detection rate of targeted biopsy in clinically significant PCa (csPCa) patients was slightly higher than that of systematic biopsy (40.83% vs 38.15%, P=0.033). Stratified analysis indicated that targeted biopsy was more advantageous in csPCa patients with PIRADS score >= 4 and ROI-load > 5%. The comparison of diagnostic sensitivity of systematic biopsy and targeted biopsy demonstrated that targeted biopsy was more sensitive than systematic biopsy to diagnose PCa (Z=2.110, P=0.035) at ROI-load <= 5%. In addition, ROI-load may be a better targeted biopsy indicator than ROI diameter for the diagnosis of PCa (Z=2.168, P=0.030). Conclusion: MRI/US fusion targeted biopsy may be more suitable for PCa detection than systematic biopsy in patients with low ROI-load.