Related Experiment Video
Updated: Dec 10, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Real life data of MRI-targeted biopsy - experience from a single nonacademic centre using cognitive fusion and 1.5
Marco Antonio Soares Novaes1, Augusto Mota2, Daniel Abensur Athanazio3,4
1Multimagem Clinic, Salvador, Brazil.
Objectives:
To date, it is unknown whether systematic biopsies can be safely omitted in patients with unsuspicious MRI findings or if systematic biopsies should be required when targeting focal lesions (PI-RADS 3-5).
Methods:
A series of 366 patients (249 without a previous biopsy) were examined in a 1.5 Tesla MRI scanner. All patients were submitted to systematic biopsies (12-14 regions) with additional targeted biopsies (by cognitive fusion) of focal PI-RADS lesions (PI-RADS 3-5).
Results:
In our series, patients with PI-RADS 1/2 findings had rates of adenocarcinoma of any grade, >GG1 and GG4/5 of 34%, 14% and 3%, respectively. The use of MRI prior to biopsy in our series increased the detection of clinically significant prostate cancer (CSPCa) in 28% of patients with focal lesions, and focal lesions were present in 293/366 (80%) of all patients. For CSPCa (>GG1), targeted biopsies improved the diagnosis in 28% of patients, while systematic biopsies resulted in an additional 19% of cancer cases in the series.
Conclusion:
Systematic biopsies should still be considered in patients with PI-RADS 1/2 findings. Our findings also suggest a stronger benefit of the combined strategy of targeted and systematic biopsies than the findings of previous studies concerning the detection of CSPCa in biopsy-naïve patients.
Insights
For men with PI-RADS 1/2 MRI findings, systematic biopsies are still recommended. Combining targeted and systematic biopsies improves the detection of clinically significant prostate cancer (CSPCa) in biopsy-naïve patients.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- The role of systematic biopsies alongside MRI-targeted biopsies for prostate cancer detection remains debated.
- Uncertainty exists regarding the necessity of systematic biopsies for PI-RADS 3-5 lesions and PI-RADS 1-2 findings.
Purpose of the Study:
- To evaluate the necessity of systematic biopsies in patients with unsuspicious MRI findings (PI-RADS 1-2).
- To determine if systematic biopsies are required when targeting focal lesions (PI-RADS 3-5).
- To assess the combined benefit of targeted and systematic biopsies for clinically significant prostate cancer (CSPCa) detection.
Main Methods:
- A cohort of 366 patients (249 biopsy-naïve) underwent 1.5 Tesla MRI.
- All patients received systematic biopsies (12-14 regions).
- Targeted biopsies were performed on focal PI-RADS 3-5 lesions using cognitive fusion.
Main Results:
- Patients with PI-RADS 1/2 findings showed a 34% rate of any-grade adenocarcinoma.
- MRI prior to biopsy increased CSPCa detection by 28% in patients with focal lesions.
- The combined biopsy strategy detected an additional 19% of cancer cases compared to targeted biopsies alone.
Conclusions:
- Systematic biopsies remain crucial for patients with PI-RADS 1-2 MRI findings.
- A combined targeted and systematic biopsy approach offers superior CSPCa detection in biopsy-naïve patients compared to previous studies.
Related Concept Videos
01:24Magnetic Resonance Imaging
01:14Brain Imaging
These technologies include computerized axial tomography (CAT or CT scans), positron-emission tomography (PET scans), magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), and Transcranial Magnetic...