Prostate cancer therapeutic strategies decided based on in-bore MRI-targeted prostate biopsies alone, or in combination with TRUS-guided biopsies
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Updated: May 9, 2026
Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Alexandre Schull1, Julie Gachet2, Sebastian Tavolaro3
1Olympe Imagerie, Ramsay Santé, 25 avenue de la Providence, Antony, 92160, France. alexandre.schull@olympe-imagerie.fr.
Purpose:
The purpose was to evaluate the concordance of prostate cancer therapeutic decisions based on in-bore MRI-targeted biopsies (MRI-TB) alone, with decisions based on combined in-bore MRI-TB and systematic US-guided biopsies.
Methods:
We included male biopsy-naïve patients, aged between 50 and ≤ 75 years, with PSA greater than 4 and/or a pathological digital rectal examination in this single-centre, exploratory, prospective, interventional study. All patients received T2-weighted MRI between November 2022 and May 2024, presenting a single lesion with a positive Prostate Imaging Reporting and Data System (PI-RADS) score ≥ 3. In-bore MRI-TB were carried out with the assistance of a Remote-Controlled Manipulator. A second operator (radiologist), blind to in-bore MRI-TB results, carried out systematic 12-core TRUS-guided biopsies.We evaluated concordance of therapeutic decisions decided in a multidisciplinary team meeting (MDT1) based on in-bore MRI-TB only, with decisions based on the combined biopsies (MDT2, blind to MDT1 decision). ISUP score and cancer detection concordance, and tolerance and acceptability of the procedures were evaluated.
Results:
Fifty patients were included, with average age 63.4 years (SD 6.9). Therapeutic strategies were aligned for 43 patients, with a weighted Cohen's Kappa of 0.81 [95%CI 0.67;0.95], within the very good range. ISUP score concordance was very good (0.82 [0.68;0.97]) and cancer detection concordance was strong (0.63 [0.38;0.89]). Pain was higher after TRUS-guided biopsies. Fourteen (28%) patients preferred in-bore MRI-TB and 7 (14%) preferred TRUS-guided and 29 (58.0%) had no preference. No infections were recorded.
Conclusion:
MRI-targeted biopsies reduce pain for patients. However, while there was excellent concordance between the two methods for therapeutic decisions and ISUP scores, the lower concordance for cancer detection means that systematic biopsies cannot yet be omitted for prostate cancer diagnosis.
Insights
In-bore MRI-targeted biopsies (MRI-TB) show high concordance with combined methods for prostate cancer treatment decisions, reducing patient pain. However, systematic biopsies remain necessary for accurate cancer detection.
Area of Science:
- Urology
- Oncology
- Radiology
Background:
- Prostate cancer diagnosis often involves biopsies.
- MRI-targeted biopsies (MRI-TB) offer precise lesion targeting.
- Systematic US-guided biopsies are the current standard.
Purpose of the Study:
- To compare therapeutic decisions based on MRI-TB alone versus combined MRI-TB and systematic biopsies.
- To evaluate concordance in treatment planning for prostate cancer.
- To assess cancer detection and ISUP score agreement between methods.
Main Methods:
- Prospective study of biopsy-naïve men (50-75 years) with elevated PSA or abnormal DRE.
- In-bore MRI-TB performed using a Remote-Controlled Manipulator.
- Systematic 12-core TRUS-guided biopsies conducted by a radiologist blinded to MRI-TB results.
- Multidisciplinary team meetings (MDT) evaluated decisions based on each biopsy method.
Main Results:
- High concordance (Kappa=0.81) in therapeutic decisions between MRI-TB alone and combined methods.
- Very good concordance for ISUP scores (0.82) and strong for cancer detection (0.63).
- MRI-TB resulted in less pain compared to TRUS-guided biopsies; no infections reported.
Conclusions:
- MRI-targeted biopsies alone demonstrate excellent concordance for prostate cancer treatment decisions and ISUP scoring.
- Systematic biopsies are still crucial for comprehensive cancer detection.
- MRI-TB offers a less painful biopsy experience for patients.
