Related Experiment Video
Updated: Jun 17, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Validation of the Barcelona-MRI predictive model when PI-RADS v2.1 is used with trans-perineal prostate biopsies
Juan Morote1,2, Nahuel Paesano2,3, Natàlia Picola4
1Department of Urology, Hospital Univeritari Vall d´Hebron, Barcelona, Spain.
Purpose:
To validate the Barcelona magnetic resonance imaging predictive model (BCN-MRI PM) in men with pre-biopsy multiparametric MRI (mpMRI) reported with the Prostate Imaging Reporting and Data System (PI-RADS) v2.1, followed by transrectal and transperineal prostate biopsies.
Materials And Methods:
Prospective analysis of 3,264 men with PSA >3.0 ng/mL and/or abnormal digital rectal examination who were referred to ten participant centers in the csPCa early detection program of Catalonia (Spain), between 2021 and 2023. MpMRI was reported with the PI-RADS v2.1, and 2- to 4-core MRI-transrectal ultrasound (TRUS) fusion-targeted biopsy of suspected lesions and/or 12-core systematic biopsy were conducted. 2,295 (70.3%) individuals were referred to six centers for transrectal prostate biopsies, while 969 (39.7%) were referred to four centers for transperineal prostate biopsies. CsPCa was classified whenever the International Society of Urologic Pathology grade group was 2 or higher.
Results:
CsPCa was detected in 41% of transrectal prostate biopsies and in 45.9% of transperineal prostate biopsies (p < 0.016). Both BCN-MRI PM calibration curves were within the ideal correlation between predicted and observed csPCa. Areas under the curve and 95% confidence intervals were 0.847 (0.830-0.857) and 0.830 (0.823-0.855), respectively (p = 0.346). Specificities corresponding to 95% sensitivity were 37.6 and 36.8%, respectively (p = 0.387). The Net benefit of the BCN-MRI PM was similar with both biopsy methods.
Conclusions:
The BCN-MRI PM has been successfully validated when mpMRI was reported with the PI-RADS v2.1 and prostate biopsies were conducted via the transrectal and transperineal route.
Insights
The Barcelona magnetic resonance imaging predictive model (BCN-MRI PM) accurately predicts clinically significant prostate cancer (csPCa) in men undergoing multiparametric MRI (mpMRI) and biopsy. Validation confirms its reliability across both transrectal and transperineal biopsy methods.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Multiparametric MRI (mpMRI) with Prostate Imaging Reporting and Data System (PI-RADS) v2.1 is crucial for detecting clinically significant prostate cancer (csPCa).
- Predictive models aid in risk stratification and decision-making for prostate biopsies.
- The Barcelona magnetic resonance imaging predictive model (BCN-MRI PM) requires validation in diverse clinical settings.
Purpose of the Study:
- To validate the BCN-MRI PM in men with pre-biopsy mpMRI (PI-RADS v2.1).
- To assess the model's performance using both transrectal and transperineal prostate biopsy techniques.
- To confirm the BCN-MRI PM's utility in early detection programs for prostate cancer.
Main Methods:
- Prospective analysis of 3,264 men with elevated PSA or abnormal DRE in Catalonia, Spain (2021-2023).
- mpMRI interpreted using PI-RADS v2.1, followed by MRI-TRUS fusion-targeted and/or systematic biopsies.
- Comparison of outcomes between transrectal (n=2,295) and transperineal (n=969) biopsy cohorts.
Main Results:
- Clinically significant prostate cancer (csPCa) detection rates were 41% (transrectal) and 45.9% (transperineal).
- BCN-MRI PM demonstrated strong calibration and predictive accuracy (AUC 0.847 and 0.830).
- Model performance and net benefit were similar for both biopsy routes, with specificities around 37% at 95% sensitivity.
Conclusions:
- The BCN-MRI PM is successfully validated for predicting csPCa.
- The model performs reliably regardless of whether transrectal or transperineal biopsy is used.
- This validation supports the BCN-MRI PM's role in guiding prostate cancer diagnosis.
