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.
Multiparametric MRI (mpMRI) alone may misjudge prostate cancer laterality. Combining mpMRI with biopsy data improves accuracy for selecting patients for focal therapy.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Accurate tumor laterality assessment is crucial for focal therapy selection.
- Multiparametric MRI (mpMRI) can underestimate pathological disease extent.
- Integrating imaging with clinical and biopsy data may enhance patient selection.
Purpose of the Study:
- To evaluate if mpMRI-defined unilateral disease accurately reflects true organ-confined laterality.
- To determine if integrating imaging with clinical and biopsy variables improves patient selection for focal therapy.
Main Methods:
- Cross-sectional analysis of 232 patients undergoing radical prostatectomy with preoperative mpMRI and biopsy.
- Radiological staging using PI-RADS v2.1 and TNM criteria; whole-mount prostatectomy specimens as reference.
- Analysis of diagnostic accuracy, concordance, and predictors of disease extent using logistic regression.
Main Results:
- mpMRI showed moderate agreement (51.7%) with pathology and overestimated organ-confined disease.
- While sensitive (84.8%), mpMRI staging had limited specificity (51.8%) for unilateral disease.
- A model combining mpMRI stage, biopsy laterality, and positive core percentage improved prediction (AUC 0.78-0.79).
Conclusions:
- mpMRI alone may overestimate unilateral prostate cancer.
- Integrating biopsy-derived tumor burden and laterality enhances pathological prediction.
- This integrated approach supports safer patient selection for focal therapy.
