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Updated: Jun 18, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Are Big Prostates a Challenge? Correlation Between Prostate Volume and Detection Rate in Fusion Biopsy of the
Toni Franz1, Tom Sicker1, Julian Lueke1
1Department of Urology, University of Leipzig, Liebigstraße 20a, Leipzig, 04103, Germany, uni-leipzig.de.
Background:
This study investigates the relationship between prostate cancer (PCa) detection rates and prostate volume. Prostate volume may influence the diagnostic performance of MRI-ultrasound (MRI-US) fusion biopsy. Enlarged prostate glands present specific challenges, including reduced specificity of prostate-specific antigen (PSA), anatomical alterations of the transition zone, and potential limitations in biopsy accuracy.
Material And Methods:
We retrospectively analyzed 1300 consecutive patients with elevated PSA and/or abnormal digital rectal examination (DRE) who underwent MRI-US fusion-guided biopsy between 2014 and 2023. Patients were stratified into five prostate volume groups (< 30, 30-54.9, 55-79.9, 80-119.9, and ≥ 120 mL). For PI-RADS-based analyses, three volume categories (< 50, 50-100, and > 100 mL) were applied. Detection rates for overall PCa and clinically significant prostate cancer (csPCa) were assessed.
Results:
A total of 1203 patients were included. The overall cancer detection rate was 62.0% (746/1203), with 39.5% (475/1203) classified as clinically significant. Detection rates decreased significantly with increasing prostate volume, from 82.3% in prostates < 30 mL to 28.9% in prostates ≥ 120 mL (p < 0.01). Intermediate groups showed detection rates of 67.1%, 50.2%, and 48.5% for volumes of 30-54.9, 55-79.9, and 80-119.9 mL, respectively. A similar trend was observed for csPCa detection (59.4%, 42.3%, 27.4%, 31.5%, and 24.4%; p < 0.05). In multivariable analysis, prostate volume remained an independent predictor of cancer detection (OR: 0.99, p < 0.01). Stratified by PI-RADS category, detection rates consistently declined with increasing prostate size. For PI-RADS 5 lesions, detection decreased from 87.1% in prostates < 50 mL to 83.1% in 50-100 mL and 69.2% in > 100 mL (p < 0.01). Comparable trends were observed for PI-RADS 4 lesions (78.5%, 64.0%, and 50.0%) and PI-RADS 3 lesions (45.9%, 40.7%, and 31.8%; p < 0.05). Additionally, larger prostates were associated with a higher proportion of anterior lesions and a decreasing rate of positive DREs.
Conclusion:
Prostate volume is an independent determinant of cancer detection in MRI-US fusion biopsy. Larger prostate glands are associated with significantly reduced detection rates across all PI-RADS categories. These findings highlight the need to consider prostate volume in diagnostic decision-making and to adapt biopsy strategies in patients with enlarged prostates.
