Related Experiment Video
Updated: Sep 10, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Software mpMR/US fusion, cognitive, and in-bore biopsy: a comparative analysis of prostate cancer detection
Vladislav Petov1, Konstantin Badyan2, Vitaliy Gredzhev3
1Institute for Urology and Reproductive Health, Sechenov University, Bolshaya Pirogovskaya St. 2-1, 119435, Moscow, Russia. vladislav.s.petov@gmail.com.
Introduction:
Three MR-targeted biopsy (MR-TB) techniques-software fusion (FUS-TB), cognitive (COG-TB), and in-bore (IB-TB)-are considered comparable by EAU guidelines, although recommendations remain weak. This study aimed to compare detection rates of clinically significant (csPCa), insignificant (cisPCa), and overall prostate cancer (PCa).
Materials And Methods:
This prospective, non-randomized, controlled bicentric study (2019-2024) included biopsy-naïve and previously negative biopsy patients with suspected PCa (PSA ≥ 2 ng/mL, TRUS lesion, positive DRE and PI-RADSv2.1 score ≥ 3). FUS-TB was performed transperineally (3-5 cores) with template mapping biopsy (TPMB; > 20 cores), while COG-TB and IB-TB were performed transrectally (3-5 and 2-3 cores, respectively). COG-TB was combined with standard biopsy (TRUS-GB; 8-12 cores). CsPCa was defined as ISUP grade group ≥ 2.
Results:
In total, 481 patients were enrolled: 334 underwent FUS-TB + TPMB, 102-COG-TB + TRUS-GB, and 45-IB-TB. PCa detection was similar among groups: FUS-TB (43.4%), COG-TB (42.1%), and IB-TB (40.0%) (p = 0.89). CsPCa detection was also comparable: 23.1%, 30.3%, and 35.5%, respectively (p = 0.09). Subgroup analysis by PI-RADS and multivariable logistic regression confirmed no significant differences in csPCa detection. IB-TB yielded the lowest cisPCa detection (4.4%, p < 0.01). Adding systematic biopsy to FUS-TB and COG-TB resulted in non-significant increases in csPCa detection (+ 6.6%, p = 0.054; + 4.0%, p = 0.55). There were not considerable differences in positive core proportion (p = 0.76), maximum cancer core length (MCCL) (p = 0.08), or ISUP concordance (p = 0.2).
Conclusion:
MR-TB techniques demonstrate comparable csPCa detection after adjustment. IB-TB may reduce overdiagnosis due to lower cisPCa detection rates. Systematic biopsy provides limited additional value, but all results should be interpreted with caution given the study's design.
