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Updated: May 3, 2026
Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
PSMA-Targeted Biopsy With Fusion Guidance for Detecting Clinically Significant Prostate Cancer in Men With Negative
Lorenzo Bianchi1, Danilo Cangemi2, Andrea Farolfi3
1Division of Urology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy; University of Bologna, Bologna, Italy.
Introduction:
Contemporary prostate biopsy utilizes multiparametric magnetic resonance (MRI) guidance; however, it may fail to identify a non-negligible proportion of men with clinically significant (csPCa). The main objective of this study was to assess the feasibility and diagnostic performance of Prostate Specific Membrane Antigen-Target biopsy (PSMA-TB) to diagnose csPCa in men with negative MRI and high clinical risk of PCa.
Patients And Methods:
Open-label, single-center, nonrandomized, prospective study.
Inclusion Criteria:
PSA density (PSAd) ≥0.2 ng/ml2 in men with PIRADS 1-2; PSA >10 ng/ml or abnormal digital rectal examination or strong familiar history for PCa or known genetic mutation. Each patients underwent PSMA-PET and transperineal fusion PSMA-TB ± systematic biopsy (SB).
Results:
Overall, 35 patients were enrolled; 23 (65.7%) men had positive PSMA-PET (PRIMARY score ≥3). Overall, 14 (40%) men had csPCA and 21 (60%) patients had any PCa at PSMA-TB+SB. Only 1 patient (8.3%) with negative PSMA-PET had csPCa (ISUP 3) at SB (92% Negative Predictive Value [NPV]). Fusion PSMA-TB alone detected csPCa in 12 out of 23 (52.2%) patients with positive PSMA-PET; fusion PSMA-TB with concomitant SB increased the detection of csPCa to 56.5% (added value of 4.3%). The sensitivity, specificity, Positive Predictive Value (PPV), NPV and AUC of PSMA-TB+SB were 93%, 57%, 59%, 92% and 0.75 for detection of csPCa and 91%, 79%, 86%, 95% and 0.84 for detection of any PCa, respectively. The main limitation of this study is its small sample size.
Conclusions:
Fusion PSMA-TB is technically feasible and may improve the detection of csPCa in patients with negative MRI.
