Optimization of primary transrectal multifocal prostate biopsy using perfusion computed tomography

Introduction. Primary transrectal multifocal prostate biopsy is the standard method for prostate cancer (PCa) verification, with the detection rate of 53 %. The purpose of the study was to improve findings of transrectal ultrasound-guided prostate biopsy (TRUS-biopsy) by its optimization due to perfusion computed tomography (PCT). material and methods. The study included 97 patients with indications for TRUS-biopsy. All patients underwent PCT of the prostate before biopsy. Prostate cancer was detected by PCT in 43 patients. These patients underwent standard primary transrectal multifocal prostate biopsy plus additional targeted punctures from areas of increased blood flow. The results of standard and targeted punctures were compared. The McNemar criterion was used to assess the statistical significance of the differences. results. There were no statistically significant differences in the incidence of PCa detection between standard and targeted punctures (p>0.05). However, statistically significant differences in the detection of PCa of different differentiation grades were found between standard and targeted punctures for PCa with a Gleason score of 8 (4 + 4). The detection rate of PCa with the Gleason score of 8 (4 + 4) was 5 % for standard punctures and 14 % for targeted punctures (p˂0.05). No one statistical method has been used to assess sensitivity and specificity, due to the absence of a «gold» standard (histological examination of the total amount of prostate tissue after radical prostatectomy). conclusion. The use of primary prostate biopsy optimized with PCT findings does not allow increase in the detection rate of PCa. However, this method improves the verification of PCa with a Gleason score of 8 (4 + 4) that can influence the risk stratification and selection of further therapeutic strategy.