Prostate cancer causes significant morbidity to the elderly male population. [Fig 7] In those with clinical concern for prostate cancer, MRI is often used as a preferred method for initial detection of a specific lesion prior to tissue sampling (e.g. see figure below). [Fig 14] Once such a lesion is detected, image-guided biopsies can be performed either with ultrasound (free-hand or with grid) or with MRI. A corresponding lesion can sometimes be visible on ultrasound although overall detection sensitivity for lesions on ultrasound is low....

In our institution, we undertake transperineal freehand ultrasound-guided biopsies for those with suspected prostate cancer. Almost all of these patients tend to have an MRI scan prior to the procedure. A retrospective analysis of 98 such transperineal free-hand prostate biopsies performedover a time period fromJanuary 2020 to November 2020 at Royal Perth Hospital was carried out. The mean age of patients was 67 with an age range of 45 to 88 years. [Fig 16] All patients had initial diagnostic MR imaging and then underwent subsequent...

A total of 98 cases were biopsied with the preceding MRI reporting: a lesion greater than PI-RADS 3 in 78 (79.6 %) cases a lesion greater than PI-RADS 4 in 61 (62.2 %) cases. a lesion of PI-RADS 5 in 28 (28.6 %) cases. Of the 98 biopsied cases, a positive histology result for a tumour of Gleason 6 or above was present in 71 % of cases. In 15 of the 78 cases (19.2 %) having lesions reported as PI-RADS 3 or above on...

Combined use of MR imaging with subsequent ultrasound-guided biopsy (trans-perineal freehand in our case) can provide a good yield in histological confirmation of prostate cancer in a particular MRI suspected location. Although ultrasound only tends to visually identify a small proportion (~19 %) of MRI detected lesions as a "sonographically visible" lesion, targeted sampling “at or adjacent (within one clock face position) to this region can yield a high (up to 93 % in our case) positive histology (Gleason 6 or above) when the MRI...

Jessica Rührup, Felix Preisser, Lena Theißen et al. MRI-Fusion Targeted vs. Systematic Prostate Biopsy-How Does the Biopsy Technique Affect Gleason Grade Concordance and Upgrading After Radical Prostatectomy?. Frontiers in surgery, 2019 Sep 18;6:55. DOI:10.3389/fsurg.2019.00055 Catherine Elizabeth Lovegrove, Mudit Matanhelia, Jagpal Randeva et al. Prostate imaging features that indicate benign or malignant pathology on biopsy. Transl Androl Urol. 2018 Sep; 7(Suppl 4): S420–S435. doi: 10.21037/tau.2018.07.06 Susanne Tewes, Inga Peters, Ansgar Tiemeyer et al. Evaluation of MRI/Ultrasound Fusion-Guided Prostate Biopsy Using Transrectal and Transperineal Approaches. Volume 2017...