Comparison of Prostate Cancer Detection Between an MRI-Directed Fusion Biopsy Strategy and Conventional Systematic...

Background/Objectives: Prostate cancer (PCa) detection via a conventional systematic biopsy (SB) may miss cancer lesions, promoting the exploration of alternative methods. Multiparametric MRI demonstrates high sensitivity and specificity for the detection of clinically significant prostate cancer and an MRI-directed three-dimensional fusion biopsy (MFB) strategy may improve cancer detection rates. There are limited data available in Taiwan regarding this novel technique. This study aimed to compare the accuracy of cancer detection rates between MFB and SB. Methods: From January, 2021 through October, 2023, patients with PSA levels of 4-20 ng/mL and no palpable prostate nodules were retrospectively reviewed. They were categorized into the MFB and SB groups. Clinical parameters and PCa detection rates were compared between the two groups. Multivariable logistic regression analyses were performed to identify independent predictors of cancer detection. A separate subgroup analysis was conducted within the MFB cohort to evaluate the association between the PI-RADS category and biopsy outcomes. Results: A total of 262 patients (89 in MFB and 173 in SB) were included in the final analysis. MFB demonstrated significantly a higher detection rate in detecting PCa compared to SB (45.0% vs. 31.8%, p = 0.036). Furthermore, MFB exhibited superior rates in detecting clinically significant PCa (csPCa) and high-grade PCa compared to SB (40.4% vs. 22.5%, p = 0.002; 20.2% vs. 5.8%, p ≤ 0.001, respectively). The MRI PIRADS score exhibited a positive correlation with the detection of PCa, csPCa, and high-grade PCa (p ≤ 0.001, p ≤ 0.001, and p = 0.015, respectively). After an adjustment for age, PSA level, and PSAD, MFB remained independently associated with overall PCa detection (adjusted OR 2.01, 95% CI 1.16-3.48, p = 0.013), csPCa detection (adjusted OR 2.83, 95% CI 1.58-5.08, p < 0.001), and high-grade PCa detection (adjusted OR 6.15, 95% CI 2.49-15.19, p < 0.001). PSAD was also independently associated with all cancer outcomes. Within the MFB cohort, PI-RADS 5 lesions demonstrated significantly higher odds of overall PCa (adjusted OR 7.38, 95% CI 2.18-24.98, p = 0.001), csPCa (adjusted OR 8.42, 95% CI 2.49-28.49, p < 0.001), and high-grade PCa detection (adjusted OR 6.93, 95% CI 1.82-26.41, p = 0.005) compared with PI-RADS 3 lesions. Conclusions: In this retrospective cohort, the MFB strategy was associated with higher detection rates of PCa, csPCa, and high-grade PCa compared with conventional SB. PSAD and MRI findings independently contributed to cancer prediction, supporting the integration of clinical and imaging parameters in prostate biopsy decision-making. These findings support the clinical value of MRI-directed biopsy strategies but should be interpreted cautiously because of the non-randomized allocation and the differences in biopsy route and sampling strategy.