Long-term follow-up after initial negative prostate biopsy-comparison of conventional transrectal ultrasound biopsy and mpMRI/transrectal ultrasound fusion guided biopsy.

Background: Men after an initial negative transrectal ultrasound (TRUS)-guided prostate biopsy have a low risk of prostate cancer (PCa) diagnosis and mortality during follow-up. It is unknown whether an initial negative multi-parametric magnetic resonance imaging (mpMRI)-guided biopsy is associated with the same risk of PCa diagnosis and mortality during follow-up. The present study aimed to describe the risk differences of developing localized, metastatic or deadly PCa after either a negative TRUS or mpMRI-guided prostate biopsy. Methods: Men after an initial negative prostate biopsy at our institution between 2005-2021 were retrospectively identified and divided into two groups, whether they received an mpMRI prior to the biopsy [magnetic resonance imaging (MRI) group] or not (no MRI group). Categorical and continuous variables were compared by Results: A total of 1,308 men underwent an initial negative prostate biopsy (84% TRUS; 16% MRI). Re-biopsies were significantly more often performed in the no MRI group (P value <0.001). The incidence rate (IR) of PCa (grade group ≥2) were 9.8 per 1,000 person-years (py) in the no MRI group and 11.9 per 1,000 py in the MRI group (P value =0.50). No metastasis or PCa specific deaths were recorded in the MRI group, whereas the IR were 1.19 and 0.17 per 1,000 py in the no MRI group. Conclusions: Men with an initial negative biopsy have a low risk of developing localized, metastatic, or deadly PCa during long-term follow-up. The biopsy technique was not significantly associated with different IRs of significant PCa diagnoses. The event rates of metastasis and PCa-specific deaths were too rare to draw any conclusions.