Trus-guided MRI fusion prostate biopsy: Our clinical experience

Aim: The aim of this thesis was to compare the detection rates and diagnostic accuracy of clinically significant prostate cancer (csPCa) among MRI-TRUS fusion prostate biopsy, cognitive fusion prostate biopsy, and systematic prostate biopsy methods used at our institution, and to evaluate their clinical efficacy. Materials and Methods: A total of 210 patients who underwent MRI-TRUS fusion prostate biopsy between February 2022 and December 2024 at the Radiology Department of Çukurova University Faculty of Medicine were retrospectively analyzed. All patients underwent biparametric prostate magnetic resonance imaging (bpMRI) prior to biopsy, and lesions were evaluated according to PI-RADS v2.1 (Prostate Imaging Reporting and Data System) criteria. Systematic biopsy was performed on 94 patients with PI-RADS score 2 lesions, while cognitive and software-based MRI-TRUS fusion biopsy techniques were applied to 116 patients with PI-RADS score ≥3 target lesions. Demographic data, PSA levels, PSA density, prostate volumes, sPSA/tPSA ratios, lesion locations and sizes, pathology outcomes, and PI-RADS scores were compared. Histopathological results were classified using the International Society of Urological Pathology (ISUP) grading system. Additionally, the csPCa detection rates within cognitive and software-based fusion biopsy groups were compared. Results: A total of 210 patients were included in the study. The overall malignancy detection rate was 36%. The mean age of patients was 64.35±8.2 years. Type 2 diabetes mellitus (DM) was present in 33.3% of patients. Post-biopsy lower urinary tract symptoms (LUTS) developed in 3.3% of cases. Of patients with target lesions, 87.6% were located in the peripheral zone, and 12.4% were located in the transitional zone. Lesions were posteriorly located in 86.7% and anteriorly in 13.3%. When pathology results were evaluated according to PI-RADS scores; csPCa detection rates for PI-RADS 2-3-4-5 lesions were 1%, 4%, 42%, and 81%, respectively, showing statistically significant differences (p<0.001). The csPCa detection rate was 30.4% in the MRI-TRUS fusion biopsy group compared to 44.68% in the cognitive biopsy group. Conclusion: In conclusion, no statistically significant superiority was found between MRI-TRUS fusion biopsy and cognitive fusion biopsy in detecting clinically significant prostate cancer. However, a relatively higher detection rate of clinically significant cancers was observed with the cognitive method. This finding suggests that, in experienced hands and with high-quality imaging devices, the cognitive fusion biopsy approach can be as effective as software-assisted systems. Keywords: Prostate Cancer, MRI-TRUS Fusion Biopsy, Cognitive Fusion Biopsy, Targeted Biopsy, PI-RADS v2.1, Clinically Significant Prostate Cancer.