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Related Experiment Video

Updated: Sep 16, 2025

A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
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Detection Rates of Prostate Cancer Across Prostatic Zones Using Freehand Single-Access Transperineal Fusion Biopsies.

Filippo Carletti1, Giuseppe Reitano1, Eleonora Martina Toffoletto1

  • 1Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy.

Cancers
|July 12, 2025
PubMed
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This summary is machine-generated.

MRI/US-fusion-guided freehand single-access transperineal prostate biopsy (FSA-TP) with both MRI-target biopsies (MRI-TBs) and systematic biopsies (SB) ensures comprehensive prostate cancer detection across all zones. Combining MRI-TBs and SB offers complementary value, with SB detecting some clinically significant prostate cancer missed by MRI-TBs alone.

Area of Science:

  • Urology
  • Radiology
  • Oncology

Background:

  • Accurate prostate cancer sampling via MRI/US-fusion-guided freehand single-access transperineal biopsy (FSA-TP) across all prostate zones remains unclear.
  • Evaluating detection rates of clinically significant (cs) and clinically insignificant (ci) prostate cancer (PCa) in each prostate zone during FSA-TP MRI-target biopsies (MRI-TBs) and systematic biopsies (SB) is crucial.

Purpose of the Study:

  • To assess the detection rates of PCa (ci and cs) in distinct prostate zones using FSA-TP MRI-TBs and SB.
  • To evaluate the correlation between MRI findings (PI-RADS) and histopathology (ISUP grade) across prostate zones.
  • To identify factors associated with PCa and csPCa in cases with discordant MRI-TB and SB results.

Main Methods:

  • A monocentric observational study of 277 patients with no prior PCa history.
Keywords:
anteriorapexdetection ratefreehandprostate cancerprostate zonesingle accesstransperineal

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  • Patients underwent FSA-TP with 3 MRI-TB cores and 14 SB cores.
  • Intraclass correlation coefficient (ICC) and multivariate logistic regression were used to analyze data.

    • Main Results:

    • FSA-TP-MRI-TB showed higher detection rates for ciPCa and csPCa in anterior, apical, and intermediate zones individually.
    • Combined MRI-TB cores showed no significant differences in detection rates across zones or regions.
    • Concordance (ICC) between radiologic and histopathologic findings was similar across all zones and regions.
    • Older age predicted PCa detected by SB only; PSA predicted PCa detected by MRI-TB only.
    • For csPCa detected by MRI-TB but not SB, age, positive digital rectal exam, PI-RADS score >3, and larger lesion size were significant predictors.

    Conclusions:

    • FSA-TP with 14 SB and 3 MRI-TB cores provides comprehensive prostate sampling, including anterior and apical zones.
    • No significant differences in detection rates were found across prostate zones when combining biopsy methods.
    • Combining SB and MRI-TB is valuable, as SB detected a small but important percentage of csPCa missed by MRI-TB alone.