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Updated: Oct 23, 2025
Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Results from a PI-RADS-based MRI-directed diagnostic pathway for biopsy-naive patients in a non-university hospital
Jeroen S Reijnen1,2, Jon B Marthinsen1, Alf O Tysland3
1Department of Radiology, Sørlandet Hospital, Kristiansand, Norway.
Purpose:
To assess the safety and performance of a MRI-directed diagnostic pathway for patients with first-time suspicion of prostate cancer in a non-university hospital.
Methods:
Between May 2017 and December 2018 all biopsy-naive patients examined in our hospital followed a MRI-directed diagnostic work-up algorithm based on PI-RADS score. In short, PI-RADS 1-2 was generally not biopsied and PI-RADS 3-5 was reviewed by a multidisciplinary team. Patients with PI-RADS 4-5 were all referred to biopsy, either transrectal ultrasound-guided biopsy or MRI in-bore biopsy for small tumors and for sites difficult to access. PI-RADS scores were compared to the histopathology from biopsies and surgical specimens for patients who had prostatectomy. Non-biopsied patients were referred to a safety net monitoring regimen.
Results:
Two hundred and ninety-eight men were enrolled. 97 (33%) had PI-RADS 1-2, 44 (15%) had PI-RADS 3, and 157 (53%) had PI-RADS 4-5. 116 (39%) of the patients avoided biopsy. None of these were diagnosed with significant cancer within 2-3.5 years of safety net monitoring. Almost all high ISUP grade groups (≥ 3) were in the PI-RADS 4-5 category (98%). Prostatectomy specimens and systematic biopsies from MRI-negative areas indicated that very few clinically significant cancers were missed by the MRI-directed diagnostic pathway.
Conclusion:
Our findings add to evidence that a MRI-directed diagnostic pathway can be safely established in a non-university hospital. The pathway reduced the number of biopsies and reliably detected the site of the most aggressive cancers.
Insights
A new MRI-directed pathway safely diagnosed prostate cancer in a non-university hospital, reducing biopsies. This approach reliably identified aggressive cancers while avoiding unnecessary procedures for many patients.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Prostate cancer diagnosis often involves invasive biopsies.
- MRI (Magnetic Resonance Imaging) offers a non-invasive imaging modality for prostate cancer assessment.
- Standard diagnostic pathways may lead to over-biopsy or missed diagnoses.
Purpose of the Study:
- To evaluate the safety and effectiveness of an MRI-directed diagnostic pathway for initial prostate cancer detection.
- To assess the performance of this pathway in a community hospital setting.
Main Methods:
- A prospective study involving biopsy-naive men with suspected prostate cancer.
- Implementation of an MRI-directed work-up algorithm based on PI-RADS scores.
- Comparison of PI-RADS scores with histopathology from biopsies and surgical specimens.
Main Results:
- 39% of patients avoided biopsy, with no significant cancers detected during follow-up.
- High-grade cancers (ISUP ≥ 3) were predominantly in the PI-RADS 4-5 category (98%).
- The MRI-directed pathway demonstrated a low rate of missed clinically significant cancers.
Conclusions:
- An MRI-directed diagnostic pathway can be safely implemented in non-university hospitals.
- This pathway effectively reduces the number of prostate biopsies performed.
- The pathway reliably identifies the location of aggressive prostate cancers.
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Published on: March 21, 2025
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