Learning curve of a multidisciplinary team for magnetic resonance imaging/transperineal ultrasonography fusion prostate biopsy.

Abstract

Introduction: This study aimed to evaluate the learning curve of transperineal magnetic resonance imaging (MRI)/ultrasound (US) fusion biopsy performed by a multidisciplinary team comprising a single urologist, radiologist, and pathologist. We analyzed the temporal changes in overall prostate cancer detection rates and clinically significant prostate cancer (csPCa) detection rates.

Methods: We retrospectively enrolled consecutive patients with clinically suspected prostate cancer (PCa) who underwent MRI/US fusion prostate biopsy at a single center from January 2019 to December 2022. The patients were divided into four cohorts based on the year of biopsy to assess temporal variations in the outcomes. Univariate and multivariate analyses were performed to model detection rate curves.

Results: Overall, 291 patients underwent targeted biopsy (TBx) and standard biopsy (SBx) during the study period. Multivariate analysis showed that the overall PCa diagnosis was significantly higher when prostate biopsy was performed after the first year (2019; 74 patients), particularly in 2022 (OR 11.68, CI 3.08-49.1). The csPCa detection rate increased significantly from 13.5% to 40.0%, p=0.03).

Conclusions: Cumulative experience and teamwork may increase the overall PCa detection rate, specifically csPCa detection rate. Transperineal MRI fusion-guided biopsies combined with a standard template provided a higher overall cancer and csPCa detection rate than the standard template or targeted biopsy alone. Multidisciplinary team meetings and procedure standardization are key factors in overcoming the learning curve.