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Updated: Dec 14, 2025
Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Who can safely evade a magnetic resonance imaging fusion-targeted biopsy (MRIFTB) for prostate imaging reporting and
Myong Kim1, Hoyoung Ryu2, Hak Jong Lee3
1Department of Urology, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
Objective:
To identify patients who can safely evade the magnetic resonance imaging fusion-targeted biopsy (MRIFTB) for prostate imaging reporting and data system (PI-RADS) 3 lesion.
Materials And Methods:
Overall, 755 men with PI-RADS 3-5 lesions who underwent MRIFTB were retrospectively analyzed. Univariate and multivariate analyses were performed to determine significant predictors for clinically significant prostate cancer (CSPCa), defined as Gleason grade group ≥ II. Detection rates and negative predictive values of CSPCa were estimated according to various clinical settings.
Results:
Median age, prostate-specific antigen (PSA), and PSA density of patients were 66.0 years, 7.39 ng/mL, and 0.19 ng/mL, respectively. Overall detection rates of CSPCa according to PI-RADS 3 (n = 347), 4 (n = 260), and 5 (n = 148) lesions were 15.0%, 30.4%, and 80.4%, respectively. The negative predictive value (NPV) of PI-RADS 3 lesion on MRI was 15.0%. On multivariate analysis, age [≥ 65 years, odds ratio (OR) = 0.427], PSA density (≥ 0.20 ng/mL2, OR = 0.234), prior negative biopsy history (OR = 2.231), and PI-RADS score (4, OR = 0.427; 5, OR = 0.071) were independent predictors for the absence of CSPCa by MRIFTB. When assessed according to various conditions, NPVs of PI-RADS 3 lesions were relatively high in subgroups with low PSA density (< 0.20 ng/mL2) regardless of age or prior biopsy history (NPV range 91.1-91.9%). Contrarily, NPVs in subgroups with high PSA density were relatively low and varied according to age or prior biopsy history groups (NPV range 50.0-86.8%).
Conclusions:
Men with the PI-RADS 3 lesion and low PSA density might safely evade the MRIFTB, regardless of age or prior biopsy history.
Insights
Men with PI-RADS 3 prostate lesions and low PSA density can likely avoid MRI-guided fusion-targeted biopsy (MRIFTB). This finding helps identify patients who may safely skip the biopsy procedure, improving patient management.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Prostate cancer diagnosis relies on imaging and biopsy.
- Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions require careful consideration for biopsy.
- Magnetic Resonance Imaging Fusion-Targeted Biopsy (MRIFTB) is a key diagnostic tool.
Purpose of the Study:
- To determine if patients with PI-RADS 3 lesions can safely avoid MRIFTB.
- To identify predictors for clinically significant prostate cancer (CSPCa) in this cohort.
Main Methods:
- Retrospective analysis of 755 men with PI-RADS 3-5 lesions undergoing MRIFTB.
- Univariate and multivariate analyses to identify predictors of CSPCa (Gleason grade group ≥ II).
- Calculation of detection rates and negative predictive values (NPVs) for CSPCa.
Main Results:
- Overall CSPCa detection rates were 15.0% for PI-RADS 3, 30.4% for PI-RADS 4, and 80.4% for PI-RADS 5.
- Low PSA density (<0.20 ng/mL²) in PI-RADS 3 lesions was associated with high NPVs (91.1-91.9%), regardless of age or biopsy history.
- High PSA density in PI-RADS 3 lesions showed lower and variable NPVs (50.0-86.8%).
Conclusions:
- Men with PI-RADS 3 lesions and low PSA density may safely forgo MRIFTB.
- Age, PSA density, prior biopsy history, and PI-RADS score are independent predictors for CSPCa absence.
- This strategy can help personalize prostate cancer diagnostic pathways.
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