Comparative Analysis of Transperineal Cognitive Fusion, Systematic, and Combined Biopsies for Prostate Cancer...

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Multiparametric MRI (mpMRI) enhances prostate cancer (PCa) detection.
• The comparative diagnostic value of cognitive fusion (CF) biopsy versus systematic biopsy (SB) for PCa remains under investigation.

Purpose of the Study:

• To prospectively evaluate the diagnostic performance of SB, CF, and their combination in patients with Prostate Imaging and Reporting Data System (PI-RADS) ≥3 lesions.
• To assess the impact of CF on risk stratification compared to SB.

Main Methods:

• 282 patients with PI-RADS ≥3 lesions underwent mpMRI followed by both SB and CF biopsy.
• Cancer detection rates and International Society of Urological Pathology (ISUP) grading were compared between SB and CF.

Main Results:

• The combined approach detected all 154 PCa cases, outperforming SB (112 cancers) and CF (135 cancers) individually.
• CF identified 42 cancers missed by SB and improved risk stratification, upgrading 38 patients.
• SB underestimated disease severity in 41 cases.

Conclusions:

• CF biopsy demonstrates superior performance over SB in detecting clinically significant PCa and refining risk stratification.
• The combined SB and CF approach offers the highest diagnostic yield, supporting its integration into prostate cancer assessment protocols.