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Updated: Aug 8, 2026
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Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Is targeted biopsy necessary for Prostate Imaging Reporting and Data System 3 lesions?
Diğdem Kuru Öz1, Sezer Nil Yılmazer Zorlu2, Nuray Haliloğlu1
1Ankara University, School of Medicine, Department of Radiology - Ankara, Turkey.
Revista Da Associacao Medica Brasileira (1992)
|August 6, 2026
Summary
Biopsy decisions for Prostate Imaging Reporting and Data System 3 lesions should consider clinical factors due to the low prevalence of significant prostate cancer. Targeted biopsy may be important for higher PI-RADS lesions, even if they are PI-RADS 3.
Area of Science:
- Urology
- Radiology
- Pathology
Background:
- Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 categorizes lesions based on MRI findings.
- PI-RADS 3 lesions have an intermediate probability of prostate cancer, necessitating careful evaluation for biopsy.
- Understanding the histopathological outcomes of PI-RADS 3 lesions is crucial for optimizing diagnostic strategies.
Purpose of the Study:
- To determine the histopathological results of Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions.
- To assess the necessity of targeted biopsy for PI-RADS 3 lesions.
- To correlate clinical findings with histopathological outcomes in PI-RADS 3 lesions.
Main Methods:
- Retrospective analysis of 127 patients with 176 PI-RADS 3 lesions.
- All patients underwent transrectal ultrasound-magnetic resonance imaging (TRUS-MRI) fusion biopsy.
- Histopathological results were analyzed for adenocarcinoma and clinically significant prostate cancer.
Main Results:
- The prevalence of adenocarcinoma in PI-RADS 3 lesions was 9% (lesion-based).
- Clinically significant prostate cancer was detected in 1.7% of PI-RADS 3 lesions.
- No significant difference in PSA or PSA density was found between malignant and benign PI-RADS 3 lesions, though PSA density was higher in malignant cases with index lesions (p=0.046). Family history was also higher in malignant patients (p=0.028).
Conclusions:
- Clinically significant prostate cancer is infrequent in PI-RADS 3 lesions, suggesting a role for clinical factors in biopsy decisions.
- For PI-RADS 3 lesions that are the index lesion, clinical findings and risk factors (like family history) are important considerations.
- Targeting PI-RADS 3 areas may be relevant in cases with index lesions categorized as PI-RADS 4 or 5, considering disease extent.
