Abstract
Although magnetic resonance imaging （MRI）-ultrasound fusion prostate biopsy is a widely recognized diagnostic method for prostate cancer, the optimal approach for repeat biopsies is unclear. This study aimed to assess the diagnostic accuracy of repeat biopsies at our institution and identify patients who will benefit from repeat biopsies. Thirty-five patients from 2018 to 2022 were retrospectively evaluated. The enrolled patients presented with MRI-suspicious lesions and had a history of negative biopsies, but prostate-specific antigen （PSA） levels remained elevated or exceeded 4 ng/ml during follow-up. All patients underwent MRI-ultrasound fusion biopsies combined with systematic transperineal biopsies. The positive biopsy rate was 57.1％ （20/35）, and clinically significant prostate cancer （csPCa） was detected in 45.7％ （16/35） of patients. Univariate and multivariable analyses of PSA levels, Prostate Imaging Reporting and Data System version 2.1 （PI-RADS v2.1） scores, lesion locations and sizes, follow-up periods, and changes in PSA and PI-RADS v2.1 scores in biopsy-positive and biopsy-negative groups revealed significant differences in PI-RADS v2.1 scores and changes in PSA levels between the last biopsy and the follow-up period. In addition, positivity rates were significantly different between locations （peripheral zone, 78.6％; transition zone, 42.9％; base, 30.0％; mid-gland, 64.7％; and apex, 75.0％）. Cancer was not detected in 14 patients with negative results who were monitored for a median of 46.5 months. MRI-ultrasound fusion prostate biopsies detect csPCa in repeat biopsies. This method is recommended for patients with high PI-RADS v2.1 scores, significant PSA elevations over a short period, and peripheral zone lesions.
