Biparametric MRI and 41 sector map for MRI/Transrectal ultrasound fusion biopsy to increase diagnostic accuracy of prostate cancer.

Optimizing the number of prostate biopsy (PB) cores in the initial diagnosis of prostate cancer is still an open question. Increasing the number of cores can expectedly lead to a higher cancer detection rate but more frequent, and greater number of adverse effects should be considered. It is necessary to limit the number of PBs, obtained from tumor areas and areas with a high suspect of malignancy. Simplified Prostate Imaging Reporting and Data System (PIRADS) using biparametric MR imaging (bpMRI) protocol identifies 4 categories indicating the management for each one. We suggest targeted biopsy for category 3b [lesion with a volume ≥0.5 cc, homogeneous or inhomogeneous, mild/moderately or markedly hypointense on T2-weighted, hyperintense on high b value diffusion-weighted (DW) imaging and moderately hypointense on apparent diffusion coefficient (ADC) map] and category 4 (homogeneous or heterogeneous lesion intra- or extraglandular, mild/moderately or markedly hypointense on T2-weighted, hyperintense on high b value DW imaging and markedly hypointense on ADC map). For a precise localization of the suspected prostate lesions we used a model of 41 sectors/regions map. BpMRI/Transrectal ultrasound fusion-targeted biopsy and the 41 sectors map represent a valid alternative model to the core biopsy of 10-12 systematic transrectal or transperineal peripheral zone biopsies.