Related Experiment Video
Updated: May 12, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Radiologic and Pathologic Concordance of Multiparametric MRI for Detecting Unilateral Prostate Cancer: Implications
Miguel Angel Rodríguez-Cabello1, Santiago Méndez-Rubio1, David Vázquez-Alba2
1Department of Urology, Hospital Universitario Sanitas La Moraleja, Avenida de Francisco Pi y Margall, 81, 28050 Madrid, Spain; Fundación Sanitas Hospitales para el Desarrollo de la Investigación y la Innovación Médica, Calle Ribera del Loira, 52, 28042 Madrid, Spain; Facultad de Medicina, Universidad Francisco de Vitoria, Ctra. Pozuelo-Majadahonda Km 1,800, 28223, Pozuelo de Alarcón, Madrid, Spain.
Background:
Accurate selection for focal therapy depends on reliable assessment of tumor laterality. Although multiparametric MRI improves local staging, unilateral findings often underestimate pathological disease extent. We hypothesized that mpMRI-defined unilateral disease does not consistently reflect true organ-confined laterality and that integrating imaging with clinical and biopsy variables enhances patient selection.
Methods:
A cross-sectional analysis of a consecutive cohort of patients was conducted undergoing radical prostatectomy between 2016 and 2025. All patients had preoperative multiparametric MRI (mpMRI) and combined targeted plus systematic biopsy. Radiological staging was assigned according to PI-RADS v2.1 and TNM criteria. Whole-mount prostatectomy specimens served as the reference standard. Unilateral organ-confined disease (pT2a-pT2b) was grouped as pT2ab and defined as the pathological endpoint of interest. Diagnostic accuracy, radiological-pathological concordance, and predictors of bilateral or locally advanced disease were analyzed using logistic regression models.
Results:
Among 232 patients, 66 (28.4%) had unilateral organ-confined disease (pT2ab) and 166 (71.6%) had bilateral or locally advanced disease. Baseline clinical variables were comparable between groups. mpMRI showed moderate radiological-pathological agreement (51.7%; κ = 0.30) and systematically overestimated organ-confined disease. Although rT2ab staging was highly sensitive for pT2ab (84.8%), specificity was limited (51.8%). A parsimonious multivariable model combining radiological T stage, biopsy laterality, and percentage of positive cores improved discrimination (AUC 0.78-0.79), showed excellent calibration, and enabled clinically meaningful rule-out and rule-in strategies across predefined probability thresholds.
Conclusions:
mpMRI alone may overestimate unilateral disease; integrating biopsy-derived tumor burden and laterality improves pathological prediction and supports safer candidate selection for focal therapy.
