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Updated: May 28, 2026
Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Spatial Distribution of Prostate Cancer Missed by MRI-Targeted Biopsy, Effect of a Perilesional Template, and
Ruth Himmelsbach1, Julia Franz1, Cordula Jilg1
1Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany.
Purpose:
Systematic biopsy (SB) remains recommended in addition to MRI-targeted biopsy (TB) because TB alone may miss clinically significant prostate cancer (sPC). We evaluated the spatial distribution of sPC and clinically insignificant prostate cancer (iPC) detected by SB in relation to MRI lesions and assessed the effect of perilesional template (PLT) in terms of cancer detection.
Materials And Methods:
We retrospectively analyzed 1043 men who underwent combined transperineal MRI/TRUS fusion biopsy. Spatial distribution between MRI lesions and cancer-positive SB cores was calculated. Hypothetical PLTs with 5, 10, and 15 mm were modeled. Radical prostatectomy (RP) whole-mount histopathology served as the reference standard.
Results:
sPC was detected in 521/1043 (50.0%) men. SB alone identified sPC in 98 patients. The mean distance to the nearest sPC core was significantly shorter than for iPC (7.8 vs. 12.4 mm; p < 0.001). Cumulative sPC detection increased up to approximately 10 mm from the lesion border and plateaued thereafter, whereas iPC detection increased linearly beyond 10 mm. A 10mm-PLT would have detected 94.3% of all cancers and avoided 3.7% of iPC diagnoses, while missing 2.5% of sPC. Extending the margin to 15 mm did not meaningfully improve sPC detection but increased iPC detection. Use of 10mm-PLT would have resulted in 10.5% upgrades to sPC in RP compared to 5.9% in the TB + SB cohort.
Conclusions:
sPC is spatially concentrated near MRI lesions, whereas iPC is more widely distributed. A 10mm-PLT captures most sPC and provides an empirical basis for the guideline-recommended perilesional margin. Prospective validation is required before SB can be safely replaced.
