Systematic Review and Meta-Analysis Comparing Cognitive vs. Image-Guided Fusion Prostate Biopsy for the Detection of Prostate Cancer

The availability of image-guided fusion prostate biopsy platforms has changed the landscape for the screening and detection of prostate cancer, being incorporated into standard of care guidelines for men with suspicious lesions identifiable on prostate MRI. Despite improvements in the detection of clinically significant prostate cancer with image-guided fusion biopsy platforms, they are not widely available to patients, particularly in community settings. Several reasons may contribute to this. Image-guided biopsy platforms can be costly and the procedure is lengthier than a standard transrectal ultrasound biopsy, particularly owing to the image-acquisition and co-registration functions performed at the time of the fusion biopsy. Despite these financial and procedure length considerations, image-guided fusion biopsies are reimbursed at the same rate as a standard transrectal ultrasound-guided biopsy.

As such, cognitive fusion biopsy is utilized in some practice and centers where an image-guided platform is either unavailable, where the urologist (or, in some cases, radiologist) prefers cognitive fusion over image-guided fusion, or where the additional procedure time associated with the use of an image-guided platform is unappealing from a practice financial or patient comfort standpoint.

As such, we conducted a systematic review and meta-analysis of the literature pertaining to rates of overall and clinically significant prostate cancer detection directly compared within individual articles by cognitive and image-guided fusion prostate biopsy for MRI-identifiable suspicious lesions. Overall, there was a trend toward improved rates of overall and clinically significant prostate cancer by image-guided fusion biopsy platforms, although it did not reach statistical significance. One study in particularly likely contributed to this, as it strongly favored cognitive fusion biopsy.¹ There was moderate but insignificant heterogeneity between the seven studies evaluated.

One variable that is very relevant when considering outcomes associated with either image-guided or cognitive fusion prostate biopsy, particularly the latter, is provider experience. This very important qualifier was not able to be evaluated for the purposes of this meta-analysis, but it certainly warrants consideration in practice.

Written by: Kara L Watts, Laena Frechette, Ben Muller, Dan Ilinksy, Evan Kovac, Alex Sankin, Ahmed Aboumohamed

Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Department of Urology, Bronx, NY., Albert Einstein College of Medicine, Bronx, NY., Washington University, St Louis, MO., Montefiore Medical Center, Department of Urology, Bronx, NY., Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Department of Urology, Bronx, NY.

Reference:

1. Kam, Jonathan, Yuigi Yuminaga, Raymond Kim, Kushlan Aluwihare, Finlay Macneil, Rupert Ouyang, Stephen Ruthven, and Mark Louie-Johnsun. "Does magnetic resonance imaging–guided biopsy improve prostate cancer detection? A comparison of systematic, cognitive fusion and ultrasound fusion prostate biopsy." Prostate international 6, no. 3 (2018): 88-93.

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