Traditional ultrasonography-based prostate biopsy uses a transrectal approach for systematic sampling of 12 cores. The magnetic resonance imaging (MRI) fusion biopsy uses a targeted approach, first identifying regions of interest (ROI) clinically suspicious for prostate cancer (PCa) through MRI, before performing a prostate biopsy aided by ultrasonography.

The single-center institutional retrospective cohort study used 442 men who were recommended for localized PCa management. Cohort A (n = 346) comprised patients who underwent MRI-guided TRUS biopsies, which included both standard 12-core TRUS biopsies and MRI-targeted biopsies performed simultaneously. Cohort B (n = 96) comprised patients who received only standard TRUS biopsy. The primary endpoint was Gleason reclassification, defined as the change in Gleason scores between standard TRUS and targeted region-of-interest (ROI) biopsies among cohort A. Secondary endpoint assessed the role of ROI biopsies in mitigating overtreatment by analyzing the probability of undergoing treatment and the duration of active surveillance (AS).

Among men classified as no tumor on standard biopsy, 16.9 % showed Gleason disease on subsequent ROI biopsy. Additionally, ROI group also had a longer time to receive primary treatment (P = .017), as they were more likely to opt for AS (54 %). Lastly, median time spent on AS was longer for the ROI group compared with the non-ROI cohort (P = .002).

Adding multiparametric MRI (mpMRI) biopsy to standard TRUS biopsy may increase the detection of PCa. Additionally, mpMRI may allow patients to remain safely on AS, thereby reducing the need of prostate biopsies and improving cost-effectiveness.

The study compares the results of cognitive MRI-ultrasonography fusion prostate biopsy in two positions: left lateral decubitus (LLD) and lithotomy.

From June 2023 to December 2024, 200 patients were randomly assigned to two groups (100 in LLD and 100 in lithotomy). Age, BMI, prostate volume, comorbidities, PSA levels, DRE (+) status, and PI-RADS ≥ 3 lesions were recorded. Pain was measured using the visual analog scale (VAS), and complications were monitored. Histopathological results were collected and analyzed.

No significant differences were found between the groups in terms of age, BMI, PSA, DRE status, prostate volume, comorbidities, or PI-RADS ≥ 3 lesions. Cancer detection rates were 38% in the LLD group and 32% in the lithotomy group (p = 0.550). The average VAS score was lower in the LLD group (2.41 ± 2.30) compared to the lithotomy group (3.22 ± 2.88) (p = 0.030). The mean Gleason score was similar between groups (LLD: 7.05 ± 1.11, Lithotomy: 7.29 ± 1.04; p = 0.247). No major complications occurred, but hematuria was more frequent in the lithotomy group (p = 0.006).

There were no significant differences in cancer detection rates or grades between the two groups. The lithotomy position had slightly higher pain scores but no major complications. Hematuria occurred more often in the lithotomy position. Cognitive MRI-US fusion biopsy is safe in both positions.

To develop and validate a Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1 (v2.1)-based predictive model for diagnosis of clinically significant prostate cancer (csPCa), integrating clinical and multiparametric magnetic resonance imaging (mpMRI) data, and compare its performance with existing models.

We retrospectively analysed data from patients who underwent prospective mpMRI assessment using the PI-RADS v2.1 scoring system and biopsy at our institution between April 2019 and December 2023. A 'Clinical Baseline' model using patient demographics and laboratory results and an 'MRI Added' model additionally incorporating PI-RADS v2.1 scores and prostate volumes were created and validated on internal and external patients. Both models were compared against two previously published MRI-based algorithms for csPCa using area under the receiver operating characteristic curve (AUC) and decision curve analysis.

A total of 1319 patients across internal and external cohorts were included. Our 'MRI Added' model demonstrated significantly improved discriminative ability (AUCinternal 0.88, AUCexternal 0.79) compared to our 'Clinical Baseline' model (AUCinternal 0.75, AUCexternal 0.68) (P < 0.001). The 'MRI Added' model also showed higher net benefits across various clinical threshold probabilities and compared to a 'biopsy all' approach, it reduced unnecessary biopsies (defined as biopsies without Gleason Grade Group ≥2 csPCa) by 27% in the internal cohort and 10% in the external cohort at a risk threshold of 25%. However, there was no significant difference in predictive ability and reduction in unnecessary biopsies between our model and comparative ones developed for PI-RADS v2 and v1.

Our PI-RADS v2.1-based mpMRI model significantly enhances csPCa prediction, outperforming the traditional clinical model in accuracy and reduction of unnecessary biopsies. It proves promising across diverse patient populations, establishing an updated, integrated approach for detection and management of prostate cancer.

We aim to critically assess Microultrasound (mUS) clinical performance in an outpatient setting, focusing on its ability to reduce unnecessary diagnostic procedures, potentially reshape prostate cancer (PCa) diagnostic protocols, and increase the ability to rule out clinically significant (Gleason Score ≥ 3 + 4) PCa (csPCa).

Between November 2018 and April 2022, we conducted a prospective study involving men who underwent mUS examination due to clinical symptoms, PSA elevation, or opportunistic early detection of PCa. Experienced urologists performed mUS assessments in an outpatient setting using the prostate risk identification using micro-ultrasound (PRI-MUS) protocol to identify lesions suspicious of csPCa (PRI-MUS score ≥ 3). Men with negative mUS results were followed through consistent phone follow-up calls and visits until October 2023 to assess their diagnostic and therapeutic pathways. Using Cox regression models adjusted for PSA levels, DRE results, age, and previous biopsy history, we calculated the hazard ratio (HR) for biopsy-free (BFS), defined as the time from mUS to biopsy or last follow-up, cancer-free survival (CFS), and clinically significant cancer-free survival (csCFS) within the cohort based on mUS results.

Overall, 425 men were enrolled. The median (IQR) age was 66 (59-72) years, PSA levels were 5.7 (4.0-7.9) ng/mL, prostate volume was 44 (31.5-62.1) mL, and the median follow-up was 39 months (27-53). mUS identified lesions suggesting csPCa in 201/425 (47.3%) men. Overall, mUS resulted negative in 224/425 (52.7%) men, of whom 207/224 (92.4%) did not undergo subsequent mpMRI, while 22/224 (9.8%) proceeded with mpMRI according to the referring physician's decision. The latter detected suspicious lesions in 12/22 cases (54.5%), but only 2/12 (16.7%) were confirmed by biopsy as csPCa. Among those with negative mUS results, 192/224 (85.7%) men avoided additional biopsies during follow-up. Men with negative mUS results exhibited superior BFS (aHR: 0.17; p < 0.001), CFS (aHR:0.12; p < 0.001), and csCFS (aHR:0.09; p < 0.001) survival rates compared to their mUS-positive counterparts.

Our findings suggest that mUS can potentially refine patient stratification and transform PCa screening and diagnostic protocols. Pending validation by other studies, a wider implementation of mUS could optimize resource allocation, minimize wastage, and reserve additional costly tests.

Focal therapy (FT) is a rapidly growing field aiming to minimize the side effects of whole gland treatments in patients with localized prostate cancer and multiparametric MRI plays an important role in patient selection, treatment planning, and post-treatment monitoring. This article reviews the currently available prostate cancer FT techniques, discusses the key imaging findings that affect patient selection and treatment planning, and illustrates the spectrum of expected and abnormal post-treatment MRI findings.

The PRECISION and PRECISE trials compared magnetic resonance imaging targeted biopsy (MRI ± TB) with the standard transrectal ultrasound (TRUS) guided biopsy for the detection of clinically significant prostate cancer (csPCa). PRECISION demonstrated superiority of MRI ± TB over TRUS guided biopsy, while PRECISE demonstrated noninferiority. The VISION study is a planned individual patient data meta-analysis (IPDMA) comparing MRI ± TB with TRUS guided biopsy for csPCa diagnosis.

MEDLINE, EMBASE, Web of Science, Cochrane Central of Registered Trials, and ClinicalTrials.gov were searched on the November 12, 2023 for randomised controlled trials of biopsy-naïve patients with a clinical suspicion of prostate cancer undergoing MRI or standard TRUS. Studies were included if its participants with suspicious MRI underwent targeted biopsy alone and those with nonsuspicious lesion avoided biopsy. The primary outcome is the proportion of men diagnosed with csPCa (Gleason ≥3 + 4).

Two studies, PRECISION and PRECISE (953 patients), were included in the IPDMA. In the MRI ± TB arm, 32.2% of patients avoided biopsy due to nonsuspicious MRI. MRI ± TB detected 8.7 percentage points (36.3% vs 27.6%; 95% confidence interval [CI] 2.8-14.6, p = 0.004) more csPCa than TRUS biopsy and 12.3 percentage points (9.6% vs 21.9%; 95% CI 7.8-16.9, p < 0.001) less clinically insignificant prostate cancer (cisPCa; Gleason 3 + 3). The overall risk of bias for the included studies were found to be low after assessment using the QUADAS-2, QUADAS-C, and ROB 2.0 tools.

The MRI ± TB pathway is superior to TRUS biopsy in detecting csPCa and avoiding the diagnosis of cisPCa. MRI should be included in the standard of care pathway for prostate cancer diagnosis.

This meta-analysis aimed to evaluate the predictive value of multiparametric magnetic resonance imaging (mpMRI), specifically T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) maps, in the pathological grading of prostate cancer.

A comprehensive literature search was conducted across multiple databases, including PubMed, the China National Knowledge Infrastructure dataset, Web of Science, Springer Link and Cochrane Library. Studies evaluating the use of mpMRI for prostate cancer grading were included. The quality of the included studies was assessed using the risk of bias tool. Meta-analyses were performed to calculate pooled areas under the curve (AUC) and prostate cancer detection rates.

Seven studies met the inclusion criteria, comprising 843 patients in the experimental group and 962 in the control group. The meta-analysis revealed a significant improvement in diagnostic performance with mpMRI, with a pooled mean difference in AUC of 0.10 (95% confidence interval [CI]: 0.04-0.16, p = 0.002) favouring the mpMRI group. The odds ratio for prostate cancer detection was 2.60 (95% CI: 1.57-4.29, p = 0.0002), indicating a higher detection rate with mpMRI compared with standard techniques. Substantial heterogeneity was observed among the studies (I² = 73% for AUC and 66% for detection rate).

This meta-analysis demonstrates that mpMRI, particularly T2WI and ADC imaging, has a significant predictive value in the pathological grading of prostate cancer. The technique shows improved diagnostic accuracy and higher cancer detection rates compared with conventional methods. However, the substantial heterogeneity among studies suggests that standardisation of mpMRI protocols and interpretation criteria is needed.

The current standard prostate biopsy method, which combine systematic biopsy (SB) with targeted biopsy (TB), has shortcomings such as overdiagnosis and overtreatment. To evaluate the effectiveness of ipsilateral systematic biopsy (ips-SB) combined with targeted biopsy (ips-SB+TB) and contralateral SB (con-SB) combined with TB (con-SB+TB) as potential alternatives to SB+TB.

A comprehensive literature search was conducted in Cochrane, Embase, Ovid, and PubMed databases until September 2024. 2,732 references were identified, and 11 records were included.

The study included a total of 5,249 patients and revealed that ips-SB+TB detected slightly less PCa than SB+TB with a relative risk (RR) of 0.95 (95% CI 0.91, 1.00), P = 0.05. In terms of csPCa detection, ips-SB+TB showed a comparable detection rate with SB+TB (RR 0.98 [95% CI 0.94, 1.01], P = 0.60). There was a statistically significant difference in csPCa detection between con-SB+TB and SB+TB (RR 0.92 [95% CI 0.86, 0.99], P = 0.02). The detection rates of clinically insignificant PCa (ciPCa) were comparable between con-SB+TB vs. SB+TB (con-SB+TB vs. SB+TB: RR 0.90 [95% CI 0.79, 1.04], P = 0.15). However, fewer ciPCa cases were detected in ips-SB+TB compared to SB+TB (RR 0.86 [95% CI 0.75, 0.99], P = 0.04).

In this review, our analysis highlights ips-SB+TB has the comparable detection efficiency of PCa and csPCa compared to SB+TB, and its potential to be the substitute of the SB+TB with less cores and less detection of ciPCa.

The prevalence of prostate cancer (PCa) necessitates advanced diagnostic approaches for detection and lesion characterization. Utilizing two patient cohorts (n = 85), this study analyzes a custom-designed 3D ultrasonic acoustic radiation force impulse (ARFI) elasticity imaging system alongside an Index of Suspicion (IOS) lesion ranking system to evaluate reader sensitivity, positive predictive values, inter-reader reliability, and ARFI-mpMRI concordance. The IOS system provides standardized criteria for lesion assessment, enabling consistency in stratifying PCa lesion suspicion.

Three readers were trained on multiparametric ultrasound (mpUS) (combined ARFI and B-mode) prostate image volumes from 6 patients based on the IOS criteria. The readers then marked suspicious lesions in 79 patients who were retrospectively compared with histopathology-identified (Cohort I, post-radical prostatectomy) or biopsy-confirmed (Cohort II) cancerous regions.

The IOS criteria stratified lesions by Gleason grade (GG), with a higher IOS correlating with more aggressive lesions. mpUS imaging was more sensitive for detecting lesions with higher GG and preferentially identified lesions with lower MR apparent-diffusion coefficients and signs of extraprostatic extension. mpUS imaging demonstrated substantial inter-reader reliability and moderate overlap with mpMRI lesions, with increasing sensitivity to higher MRI PI-RADS score lesions. mpUS imaging was less sensitive than mpMRI to lesions with lower GG.

The increased sensitivity of mpUS imaging to higher GG lesions and adverse histopathological factors, along with moderate agreement with mpMRI, suggest that mpUS has the potential to guide biopsy targeting of mpMRI-visible lesions or serve as an alternative biopsy-targeting approach when mpMRI is unavailable or clinically contraindicated.

The efficacy of focal therapy (FT) has improved with the use of multiparametric MRI (mpMRI) for lesion identification, though standardized mpMRI reporting post-FT is lacking. The Prostate Imaging after Focal Ablation (PI-FAB) scoring system was recently introduced to standardize mpMRI interpretation for local recurrence post-FT. This study evaluates the diagnostic performance and inter-reader reliability of PI-FAB following cryoablation and high-intensity focused ultrasound (HIFU) modalities.

This retrospective, single-institution study included all patients treated with FT from 2007 to 2023 with available follow-up mpMRI and subsequent prostate biopsy. Three fellowship-trained radiologists scored these images using the PI-FAB system. The primary objective was inter-reader agreeability of PI-FAB scores, and the secondary objective assessed performance metrics, including sensitivity, specificity, positive predictive and negative predictive value.

91 patients with 113 mpMRI exams (95 post-cryotherapy; 18 post-HIFU) were reviewed. There was substantial agreement between the readers (Fleiss' Kappa (κ): 0.71, p < 0.001; Gwet AC2: 0.70, p < 0.03). A PI-FAB score 3 had a significant ability to rule-in csPCa with high specificity (88%, 86%, and 93% per reader, respectively), and PI-FAB score 1 had high sensitivity to rule out csPCa (88%, 78%, and 84% per reader, respectively) in surveillance imaging (14-16 months median follow-up).

Our study suggests that the PI-FAB scoring system can be effectively used to evaluate mpMRI recurrence post-FT, with substantial inter-reader reliability and high specificity for predicting in-field clinically significant prostate cancer recurrence post-cryotherapy and HIFU. Larger, multi-institutional studies are essential to confirm PI-FAB's utility in clinical practice.

Question There is no widely accepted and validated standardized scoring system to predict the local recurrence of clinically significant prostate cancer after focal therapy with ablative modalities. Findings The Prostate Imaging after Focal Ablation (PI-FAB) scoring system effectively predicts in-field recurrence of prostate cancer after focal therapy with substantial inter-reader reliability and specificity. Clinical relevance As patient requests for focal therapy to treat localized low- to- intermediate risk prostate cancer become more common, based on its performance metrics, PI-FAB will aid in identifying in-field recurrence within this patient population.

Our goal was to determine whether the difference between MRI-based and ultrasound (US)-based volume measurements are associated with MRI/US-targeted fusion-guided biopsy outcomes.

This retrospective, single-center study involved 4177 consecutive patients biopsied between 2010 and 2023 using both MRI/US-targeted fusion and systematic biopsy. Biopsies were indicated because of elevated PSA levels or abnormal multiparametric MRI results. US volume measurements were calculated using the triplane ellipsoid formula, and MRI volumes were obtained by semiautomatic planimetric segmentation. Performance of fusion biopsy compared with systematic biopsy was analyzed with respect to the discordance between MRI and US volume measurements.

In 2736 patients (66%), biopsy detected prostate cancer. In cases where both techniques yielded prostate cancers (1695/2736 [62%]), a statistically higher proportion of patients had higher Gleason scores on MRI/US-targeted fusion biopsy compared with systematic biopsy (343 patients [20.2%] vs 137 patients [8.1%], P < .001). MRI volume measurements were significantly smaller compared with US volume measurements (median [IQR] 54 mL [39-77], 56 mL [40-80], respectively, P < .001). Beyond 5 mL volume discordance, MRI/US-targeted fusion biopsy gradually showed less added diagnostic benefit compared with systematic biopsy. In the ≤ 5 mL cohort, MRI/US-targeted fusion biopsy detected more aggressive tumors in 4 times as many patients as systematic biopsy (136 vs 32 patients, P < .001).

Although MRI/US-targeted fusion biopsy detected more prostate cancers than systematic biopsy, the performance of MRI/US-targeted fusion biopsy declined with more discordance between volumes measured in MRI vs US. Awareness of volume discordance in MRI- and US-based volume measurements should alert the operator about the possibility of reduced performance of MRI/US-targeted fusion biopsy.

NCT00102544.

Early detection of prostate cancer (PCa) is crucial for better patient outcomes. However, due to overdiagnosis with the current biopsy strategy, there is a need to improve and refine the biopsy strategy. The aim of this study was to thoroughly evaluate existing biopsy schemes for patients with suspicious lesions.

This study conducted a systematic review and network meta-analysis following PRISMA guidelines (from their start until 15 January 2025), evaluating 13 biopsy schemes for detecting PCa in MRI-positive (PIRADS/Likert score 2-5) patients. Data from PubMed, Embase, and Cochrane databases were examined to assess the efficacy of biopsy schemes in detecting clinically significant (csPCa) and clinically insignificant (ciPCa) prostate cancer. This study is registered with PROSPERO (CRD42024551971).

The analysis included 211 studies involving 74,113 individuals. When compared with the combination of systematic biopsy (SB, defined as <20 cores) and targeted biopsy (TB, defined as <6 cores) (SB+TB), ipsilateral SB with TB (ips-SB+TB) and saturation TB did not show statistically significant inferior detection rate of csPCa (ips-SB+TB: RR 0.95, 95% CrI 0.88, 1.02; saturation TB: RR 0.96, 95% CrI 0.91, 1.01). Meanwhile, there was no significant difference in csPCa detection rates for saturation SB+TB, SB+saturation TB compared to SB+TB (saturation SB+TB: RR 1.04, 95% CrI 0.98, 1.11; SB+saturation TB: RR 1.14, 95% CrI 0.999, 1.30). TB and SB alone detected significantly less csPCa than SB+TB (TB: RR 0.86, 95% CrI 0.84, 0.88; SB: RR 0.75, 95% CrI 0.73, 0.77). Saturation SB also did not show significant superiority in detecting csPCa. Additionally, saturation TB and ips-SB+TB also decrease the detection of ciPCa. (ips-SB+TB: RR 0.87, 95% CrI 0.72, 1.04; saturation TB: RR 0.76, 95% CrI 0.65, 0.88).

The network meta-analysis reveals that saturation SB+TB and SB+saturation TB have no significant difference in csPCa detection between them and SB+TB. Meanwhile, ips-SB+TB and saturation TB are effective biopsy strategies for MRI-positive PCa patients, offering a more targeted approach for detecting csPCa.

The National Natural Science Foundation of China (Grant number: 81500522) and Science & Technology Department of Sichuan Province (Grant number: 2020YFS0090, 2020YFS0046) and Cadre Health Research Project of Sichuan Province (Grant number: ZH2023-102).

The American Academy of Pediatrics recommends up to 7 days of observation for neonatal opioid withdrawal syndrome (NOWS) in infants with chronic opioid exposure. However, many of these infants will not develop NOWS, and infants with seemingly less exposure to opioids may develop severe NOWS that requires in-hospital pharmacotherapy. We adapted and validated a prediction model to help clinicians identify infants at birth who will develop severe NOWS.

This prognostic study included 33 991 births. Severe NOWS was defined as administration of oral morphine. We applied logistic regression with a least absolute shrinkage selection operator approach to develop a severe NOWS prediction model using 37 predictors. To contrast the model with guideline screening criteria, we conducted a decision curve analysis with chronic opioid exposure defined as the mother receiving a diagnosis for opioid use disorder (OUD) or a prescription for long-acting opioids before delivery.

A total of 108 infants were treated with oral morphine for NOWS, and 1243 infants had chronic opioid exposure. The model was highly discriminative, with an area under the receiver operating curve of 0.959 (95% CI, 0.940-0.976). The strongest predictor was mothers' diagnoses of OUD (adjusted odds ratio, 47.0; 95% CI, 26.7-82.7). The decision curve analysis shows a higher benefit with the model across all levels of risk, compared with using the guideline criteria.

Risk prediction for severe NOWS at birth may better support clinicians in tailoring nonpharmacologic measures and deciding whether to extend birth hospitalization than screening for chronic opioid exposure alone.

The incidence of prostate cancer is increasing in Poland, particularly due to the aging population. This review explores the potential of deep learning algorithms to accelerate prostate contouring during fusion biopsies, a time-consuming but crucial process for the precise diagnosis and appropriate therapeutic decision-making in prostate cancer. Implementing convolutional neural networks (CNNs) can significantly improve segmentation accuracy in multiparametric magnetic resonance imaging (mpMRI).

A comprehensive literature review was conducted using PubMed and IEEE Xplore, focusing on open-access studies from the past five years, and following PRISMA 2020 guidelines. The review evaluates the enhancement of prostate contouring and segmentation in MRI for fusion biopsies using CNNs.

The results indicate that CNNs, particularly those utilizing the U-Net architecture, are predominantly selected for advanced medical image analysis. All the reviewed algorithms achieved a Dice similarity coefficient (DSC) above 74%, indicating high precision and effectiveness in automatic prostate segmentation. However, there was significant heterogeneity in the methods used to evaluate segmentation outcomes across different studies.

This review underscores the need for developing and optimizing segmentation algorithms tailored to the specific needs of urologists performing fusion biopsies. Future research with larger cohorts is recommended to confirm these findings and further enhance the practical application of CNN-based segmentation tools in clinical settings.

Background: Prostate cancer (PCa) diagnosis remains a complex field of study. Multiparametric magnetic resonance imaging (mpMRI) technology presents opportunities to enhance diagnostic precision. While recent advances in imaging and biopsy techniques show promise, the oncological implications of prebiopsy magnetic resonance imaging (MRI) and combination biopsy (ComBx) are not fully understood. This retrospective study evaluates the potential clinical impact of prebiopsy MRI and ComBx on PCa treatment outcomes. Methods: We conducted a comprehensive review of treatment-naïve patients undergoing prostate biopsy and subsequent radiation therapy (RT) or radical prostatectomy at the University of Cincinnati Health Center (2014-2020). Patients were categorized into two cohorts: those with prebiopsy mpMRI and ComBx versus those with systematic biopsy (SBx) alone. Patients with prostate-specific antigen (PSA) > 20 ng/mL were excluded. Biochemical recurrence (BCR) was defined as PSA ≥ 0.2 ng/mL post-prostatectomy or ≥2 ng/mL above nadir post-RT. Results: This study included 518 patients (189 SBx, 329 ComBx) with a median follow-up of 19.1 months. Median patient ages were 65.9 years (SBx) and 64.6 years (ComBx). The overall BCR rate was 10% with significantly lower rates in the ComBx group compared to SBx (6.4% vs. 16.4%, p < 0.001). Multivariable Cox regression analysis showed patients undergoing prebiopsy mpMRI with ComBx were 63% less likely to experience BCR (HR: 0.37, 95%CI 0.20-0.70, p = 0.002). Conclusions: Prebiopsy MRI followed by ComBx demonstrated lower BCR rates, suggesting improved PCa diagnosis and risk stratification. These findings highlight the potential of advanced imaging and biopsy techniques to benefit the management of PCa. Further longitudinal studies are needed to confirm the long-term clinical benefits of this approach.

Purpose To evaluate predictors of false-positive (FP) and false-negative (FN) results for prostate cancer at prostate multiparametric MRI (mpMRI) using the Prostate Imaging and Reporting Data System version 2 (PI-RADS v2). Materials and Methods This was a single-center retrospective cohort study of 2548 consecutive patients who underwent prostate mpMRI examinations (October 2016-July 2022) containing zero or one PI-RADS v2 category 3-5 lesions. Prostate mpMRI examinations were interpreted by 13 radiologists. FP results were defined as prospective PI-RADS v2 score of 3 or higher but benign or grade group 1 prostate cancer at subsequent combined targeted and systematic biopsy. FN results were defined as prospective PI-RADS v2 score 2 or lower but grade group 2 or higher prostate cancer at subsequent combined targeted and systematic biopsy. Predictors of FP and FN results were assessed by logistic regression. Results Among the 2548 patients (mean age, 65.7 years ± 7.6 [SD]; all male) analyzed, 52.0% (831 of 1597) had FP results and 15.8% (150 of 951) had FN results at mpMRI. FP results were more likely for younger patients (odds ratio [OR], 0.95/y; P < .001), smaller lesions (OR, 0.62/mm; P < .001), transition zone lesions (OR, 1.74 vs peripheral zone; P = .006), and patients with low prostate-specific antigen (PSA) density (OR, 0.55 per 0.1 ng/mL2 increase; P < .001). FN results were more likely for older patients (OR, 1.03/y; P = .01) and patients with high PSA density (OR, 2.05 per 0.1 ng/mL2 increase; P < .001). Conclusion PSA density and patient age independently predicted FP and FN results for detection of prostate cancer at mpMRI using PI-RADS v2. These factors are not part of the PI-RADS v2 algorithm and may inform mpMRI interpretation to improve prostate cancer diagnosis. Keywords: MR Imaging, Prostate, PI-RADS, Prostate MRI, Prostate Cancer ©RSNA, 2025.

To determine how many cores should be collected per region of interest (ROI) in magnetic resonance imaging-guided fusion prostate biopsy. Magnetic resonance imaging-guided targeted prostate biopsy has led to improved detection of clinically significant prostate cancer (csPC); however, data is limited regarding the optimal number of biopsy cores that should be taken. An ideal number of cores maximizes clinically significant cancer detection while minimizing cost, discomfort, and procedure time.

Patients receiving targeted prostate biopsy (4 cores per ROI) combined with systematic 12-core prostate at our institution between January 2017 and June 2022 were retrospectively identified. Statistical simulation was used to model scenarios in which 1, 2, 3, or 4 cores were taken from the ROI, and the rate of grade group ≥2 prostate cancer (csPC) detection was determined for targeted and combined targeted plus systematic biopsy.

483 patients were identified. Transrectal (96%) and transperineal (4%) biopsies were included. For targeted biopsy, csPC was present in 21% (1 core), 26% (2 cores; P = .048), 29% (3 cores; P = .002), and 31% (4 cores; P < .001) of cases. For combined biopsy, csPC was present in 33% (1 core), 35% (2 cores; P = .4), 37% (3 cores; P = .2), and 38% (4 cores; P = .12) of cases.

If targeted biopsy is performed without systematic biopsy, 2 or more cores is superior to 1 core for detecting csPC. This effect is mitigated when targeted and systematic biopsy are combined.

The accurate diagnosis of prostate cancer (PCa) remains challenging, particularly because standard biopsy techniques do not routinely include anterior zone, leading to potential missed diagnoses in this region. This study evaluates the accuracy and safety of biplanar stereotactic biopsy for diagnosing anterior clinically significant PCa (csPCa).

After propensity score matching analysis, data from 256 patients were retrospectively analyzed, including 128 in the biplanar group (transrectal targeted biopsy with transperineal systematic biopsy) and 128 in the monoplanar group (transperineal targeted biopsy with transperineal systematic biopsy). PCa detection rates, lesion locations, csPCa, clinically insignificant PCa (ciPCa), and complication incidences were compared. Univariable and multivariable logistic regression models evaluated factors influencing biopsy outcomes.

No significant differences were observed in overall PCa detection, ciPCa, posterior lesions, or postoperative complications between biplanar and monoplanar groups. The biplanar group demonstrated a higher detection rate for anterior csPCa (P=0.025). The overall International Society of Urological Pathology grade group (ISUP GG) distributions for Prostate Imaging Reporting and Data System (PI-RADS) scores 3 to 5 were not significantly different. Logistic regression identified age and PSA levels as independent predictors of higher detection rates, while univariable analysis showed that prostate volume had a significantly smaller effect on PCa detection rates in the biplanar group compared to the monoplanar group. Postoperative complications showed no statistically significant differences.

In conclusion, biplanar stereotactic biopsy was superior to monoplanar biopsy in detecting anterior csPCa. Both methods demonstrated no significant differences in overall PCa detection rates and safety.

Multiparametric magnetic resonance imaging (mpMRI) is pivotal in prostate cancer (PCa) diagnosis, but some clinically significant (cs) PCa remain undetected. This study aims to understand the pathological and molecular basis for csPCa visibility at mpMRI.

We performed a retrospective matched-pair cohort study, including patients undergoing radical prostatectomy (RP) for csPCa (i.e., ISUP grade group ≥ 2) from 2015 to 2020, in our tertiary-referral center. We screened for inclusion in the "mpMRI-invisible" cohort all consecutive men (N = 45) having a negative preoperative mpMRI. The "mpMRI-visible" cohort was matched based on age, PSA, prostate volume, ISUP grade group. Included patients underwent radiological and pathological open-label revisions and characterization of the tumor mRNA expression profile (analyzing 780 gene transcripts, signaling pathways, and cell-type profiling). We compared the clinical-pathological variables and the gene expression profile between matched pairs. The analysis was stratified according to histological characteristics and lesion diameter.

We included 34 patients (17 per cohort); mean age at RP and PSA were 70.5 years (standard deviation [SD] = 7.7), 7.1 ng/mL (SD = 3.3), respectively; 65% of men were ISUP 2. Overall, no significant differences in histopathological features, tumor diameter and location, mRNA profile, pathways, and cell-type scores emerged between cohorts. In the stratified analysis, an upregulation of cell adhesion and motility, of extracellular matrix remodeling and of metastatic process pathways was present in specific subgroups of mpMRI-invisible cancers.

No PCa pathological or gene-expression hallmarks explaining mp-MRI invisibility were identified. Aggressive features can be present both in mpMRI-invisible and -visible tumors.

The use of multiparametric magnetic resonance imaging (MRI) to guide prostate biopsies has improved cancer detection rates, particularly for high-grade tumors. However, despite guidelines recommending biopsies for lesions with a Prostate Imaging-Reporting and Data System (PI-RADS) score ≥ 3, the clinical significance of PI-RADS 3 lesions remains uncertain. This uncertainty, coupled with the cost and potential complications of biopsies, underscores the need for more accurate risk stratification strategies to avoid unnecessary procedures. Prostate-specific antigen density (PSAD) and index lesion volume are emerging as potential contributors to improve risk assessment.

This was a retrospective analysis of patients who had undergone an MRI-guided transrectal ultrasound (TRUS) prostate biopsy at a tertiary care institution. Patients with PI-RADS 3 lesions were included, and data on demographics, prostate-specific antigens (PSA), PSAD, lesion diameter, and pathology results were collected. The relationships between PSAD, lesion volume, and pathology outcomes were statistically analyzed.

Of the 213 patients included, 40 were diagnosed with prostate cancer. PSAD and PSAD x lesion diameter were significantly higher in the patients diagnosed with prostate cancer than those with benign lesions. Among the prostate cancer patients, clinically significant prostate cancer (csPCa) had a higher mean PSAD value than clinically insignificant prostate cancer (cisPCa). ROC analysis found PSAD x lesion diameter to have the highest discriminatory power for detecting csPCa.

MRI-guided biopsies offer targeted sampling but the clinical significance of PI-RADS 3 lesions remains uncertain. Index lesion volume and PSAD are promising adjunctive markers for risk assessment. Combining these factors could facilitate the avoidance of unnecessary biopsies and improve the detection of csPCa.

Incorporating PSAD and index lesion volume into biopsy decision-making may enhance risk stratification, particularly for PI-RADS 3 lesions. Further research is needed to validate these findings and enhance the risk assessment strategies used in making decisions regarding prostate biopsy.

As most Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions on MRI harbor Gleason grade (GG) group ≥2 disease on biopsy, optimal management of patients with imaging-biopsy discordance remains unclear. To estimate grade misclassification, we evaluated the incidence of Gleason upgrading among patients with GG1 disease in the setting of a PI-RADS 5 lesion.

We conducted a single-institution retrospective analysis to identify patients with GG1 prostate cancer on fusion biopsy with MRI demonstrating ≥1 PI-RADS 5 lesion. Primary study outcome was identification of ≥GG2 disease on subsequent active surveillance (AS) biopsy or radical prostatectomy (RP). We used multivariable models to examine factors associated with reclassification.

We identified 110 patients with GG1 disease on initial biopsy and ≥1 PI-RADS 5 lesion. There were 104 patients (94.6%) initially managed with AS and 6 (5.5%) received treatment. Sixty-one patients (58.7%) on AS underwent additional biopsies. Of these, 43 (70.5%) patients had tumor upgrading, with 32 (74.4%) upgraded on first surveillance biopsy. Forty-four (40%) patients ultimately received treatment, including prostatectomy in 15 (13.6%) and radiation in 25 (22.7%). Two patients (1.8%) developed metastases. In multivariable models, genomic classifier score was associated with upgrading. Limitations include a lack of multi-institutional data and long-term outcomes data.

Most patients diagnosed with GG1 prostate cancer on MRI-Ultrasound fusion biopsy in the setting of a PI-RADS 5 lesion were found to have ≥GG2 disease on subsequent tissue sampling, suggesting substantial initial misclassification and reinforcing the need for confirmatory testing.

Data from patients with suspicious lesions on multiparametric magnetic resonance (mpMRI) and a diagnosis of clinically significant prostate cancer (csPCa) who underwent radical prostatectomy (RP) were collected. The aim was to compare csPCa sites identified through whole-mount pathological analysis (WMA) after RP with PI-RADS ≥ 3 lesions identified on mpMRI, and with csPCa foci detected through targeted-biopsy (TB) or combined targeted + systematic biopsy (TSB). A paired Student's t-test and Pearson correlation analysis were performed to evaluate the agreement between these diagnostic methods. A total of 106 patients were included in the TSB group and 95 in the TB group. The correlation between mpMRI, PB, and WMA was moderate and comparable in both groups. No correlation between PB and WMA was found in the TB group for PI-RADS3 lesions, while a moderate-strong correlation was observed when comparing mpMRI, PB, and WMA for PI-RADS > 3 lesions. About 50% of csPCa sites remained undetected by mpMRI. TSB was able to identify 16.5% more csPCa sites than TB. mpMRI is an accurate method in the diagnosis of PCa, especially for PI-RADS > 3 lesions, although some csPCa sites remained undetected. The use of TSB improved the location agreement between PB and WMA, increasing detection rates up to 79%.

Magnetic resonance imaging (MRI) plays an important role in the management of patients with prostate cancer on active surveillance. In this review, we will explore the incorporation of MRI into active surveillance protocols, detailing its impact on clinical decision-making and patient management and discussing how it aligns with current guidelines and practice patterns. The role of MRI in this patient population continues to evolve over time, and we will discuss some of the recent advancements in the field and highlight potential areas for future research endeavors.

This article provides a comprehensive overview of prostate cancer imaging, including detection of clinically significant cancer and initial staging. The role of multiparametric MRI in detection and local staging is discussed, along with the use of conventional imaging and advanced techniques such as Prostate-Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) for staging of nodal and distant metastases. The article also highlights the importance of differentiating benign prostatic conditions from prostate cancer on imaging to improve diagnostic accuracy and reduce false-positive interpretations.

A significant proportion of men with prostate cancer will experience biochemical recurrence (BCR), which is characterized by an elevation in prostate-specific antigen (PSA) levels after receiving treatment with curative intent. Imaging plays an important role in the management of patients with BCR. It can help identify sites of recurrence to determine the most appropriate management strategies, ranging from salvage treatment for local recurrences to systemic treatments for those with advanced, distant disease. PET/CT with prostate-specific membrane antigen (PSMA)-radioligands is the most sensitive method for the detection of prostate cancer recurrence, with significantly higher cancer detection rates compared to conventional imaging techniques such as bone scan and computed tomography, even at lower PSA levels. Nevertheless, interpretation of PSMA PET/CT images can be challenging, particularly for the evaluation of local recurrence due to urinary activity that can mimic or mask the presence of cancer. Furthermore, some prostate cancers may not express PSMA and have false negative results. Multiparametric prostate MRI is an excellent method for the evaluation of local recurrence and can overcome some of the limitations of PSMA PET/CT. In this review, we discuss the role of imaging in managing patients with prostate cancer BCR and describe the potential benefits of MRI in the PSMA-radioligand imaging era, emphasizing the assessment of local recurrence.

Background and Objectives: The European Association of Urology (EAU) Guidelines on Prostate Cancer note emerging evidence suggesting that antibiotic prophylaxis may not be necessary for transperineal prostate biopsies. However, formal recommendations are pending further research. This meta-analysis compares urinary tract infection (UTI) rates following transperineal prostate biopsies with and without antibiotic prophylaxis. Materials and Methods: We searched PubMed, EMBASE, and the Cochrane Library for relevant studies published up until June 2024. The inclusion criteria were as follows: (a) patients undergoing transperineal prostate biopsy; (b) comparisons between groups with and without antibiotic prophylaxis; and (c) outcomes including UTI and sepsis rates. Exclusion criteria were studies lacking a full text or appropriate control groups and duplicates. Quality assessment was conducted using the Scottish Intercollegiate Guidelines Network checklist. Results: Nine studies (two RCTs and seven non-RCTs) met the inclusion criteria. Analysis revealed no significant difference in UTI rates between groups with and without prophylaxis (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 0.50-2.31, I2 = 0%, p = 0.86). Similarly, sepsis rates did not differ significantly (OR: 1.35, 95% CI: 0.36-5.12, I2 = 0%, p = 0.66). Conclusions: Our meta-analysis found no significant differences in UTI and sepsis rates between transperineal prostate biopsies performed with or without antibiotic prophylaxis. However, patients at high risk for UTIs may still benefit from antibiotic prophylaxis. Larger, prospective randomized trials are necessary for more conclusive evidence.

We analyzed the additional value of systematic biopsy (SB) to MR-Ultrasound fusion biopsy (MRgFbx) for detection of clinically significant prostate cancer (csPCa), as increased sampling may cause increased morbidity.

This retrospective study cohort was comprised of 1229 biopsy sessions between July 2016 and May 2020 in men who had a Prostate Imaging-Reporting and Data System (PI-RADSv2) category ≥ 3 lesion on 3 Tesla multiparametric MRI (3TmpMRI) and subsequent combined biopsy (CB; MRgFbx and SB) for suspected prostate cancer (PCa). Cancer detection rates (CDR) were calculated for CB, MRgFbx and SB in the study cohort and sub-cohorts stratified by biopsy history and PI-RADSv2 category. For 927 men with unilateral MR-visible lesions, SB CDR was additionally calculated for contralateral (SBc) and ipsilateral (SBi) subcohorts.

On CB, the CDR for csPCa was 54.8% (673/1229). CDR for csPCa was significantly higher for MRgFbx (50.0%, CI 47.1-52.8%) compared to SB (35.3%, CI 32.6-38.1%) for all PI-RADSv2 ≥ 3 categories (p < .05). The MRgFbx CDR for PI-RADSv2 categories 3, 4, and 5 were 81.5%, 88.5%, and 95.6% respectively. For unilateral lesion cases, significantly more csPCa was detected in the SBi compared to the SBc subcohort (30.1% (279/927) vs. 10.4%, (96/927), p < 0.001). The combination of MRgFbx and SBi detected csPCa in 97.0% (480) of the 495 csPCa detected by CB.

MRgFbx had a higher CDR for csPCa than SB. While CB detected more csPCa than either method alone, in patients with a PI-RADSv2 category of 5, MRgFbx approximated the performance of CB. In unilateral lesion cases, SBc provided minimal added benefit.

In-bore MRI-guided biopsy allows direct visualization of suspicious lesions, biopsy needles, and trajectories, allowing accurate sampling when MRI-ultrasound fusion biopsy is not feasible. However, its use has been limited. Wide-bore, lower-field, and lower-cost scanners could help address these issues, but their feasibility for prostate biopsy is unknown. The purpose of our study was to evaluate the feasibility of in-bore MRI-guided prostate biopsy using a large-bore (80 cm), 0.55T scanner.

Nineteen participants (68 ± 10 years) with suspected prostate cancer (PCa) were recruited for this Institutional Review Board (IRB) approved study (May 2023 -October 2024). Prebiopsy diagnostic scans and intra-procedural T2-weighted images were used for lesion localization. PSA levels, lesion sizes, cancer detection rates, positive core volume percentage, ISUP (International Society of Urological Pathology) grade groups (GG), positive volume cores, skin to target distances, and procedure durations were reported.

Seventeen participants underwent biopsies (four transrectal, thirteen percutaneous). Two participants were excluded. Twenty lesions (mean size 1.9 ± 1.2 cm) were biopsied which showed various GG cancers (GG1, GG2, GG3, GG4, and GG5), with positive cores ranging from 10 to 100%. 20% of the lesions were benign. Compared to previous biopsies, 22.2% (2/9) had new cancer detections, 22.2% (2/9) showed a GG upgrade, and 33.3% (3/9) had increased positive core volume, while 11.1% (1/9) showed no upgrade and 11.1% (1/9) had benign findings. Among biopsy-naïve participants, 75% (6/8) had cancer detected, and 25% (2/8) had benign findings. One new cancer was detected near a hip prosthesis due to reduced imaging artifacts. Average total procedure time was 77 ± 21 min for transrectal and 74 ± 22 min for percutaneous biopsies, with times to first core at 45 ± 15 and 53 ± 14 min, respectively.

Identifying and accurately targeting suspicious prostate lesions is feasible using a 0.55T MRI scanner.

Evaluation of the current status, significance and availability of multiparametric prostate MRI and MRI-guided biopsy in Germany.A voluntary web-based questionnaire with 26 distinct items was emailed to members of the German Radiological Society (DRG) and the Professional Association of German Radiologists (BDR). The questions referred to personal qualification, acquisition, quality, and management of prostate MRI, and assessment of the importance of the method.In total 182 questionnaires were captured from all 10 german postal regions (over 60% of the university hospitals, almost 50% of the maximum care hospitals and approx. 12% of the practices or medical service centers). 43% of the respondents had a Q1 or Q2 quality certificate from the DRG, 10% had a certificate from the BDR, respectively. The majority (90%) criticized inadequate reimbursement of the examination. In 47% MRI cases were discussed in an interdisciplinary tumor board, in 44% case discussions happened rarely, and 12% never had interdisciplinary discussions. On a scale from 0-100 (0%: low; 100%: high) the estimation of the clinical relevance of prostate MRIs received an average of 84% (± 16%) and the estimated approval by urologists was 75% (± 21%). Lacking clinical feedback (59%) and clinical information (42%) were perceived as the largest problems.In this representative survey the respondents estimated multiparametric MRI of the prostate as highly diagnostic and relevant with an increased approval by urologists. There is still a perceived need for continuous professional education of the method for urologists and for more widespread coverage of fusion biopsy. Prostate MRI is currently primarily offered by high volume centers. Current challenges are particularly insufficient interdisciplinary communication and inadequate reimbursement. · Prostate MRI is perceived as highly diagnostic and clinically relevant.The method is currently primarily offered by high volume centers.. · Bigger current problems are insufficient interdisciplinary communication (e.g., clinical information, biopsy results) and inadequate reimbursement.. · Continuous education for urologists and expanded coverage by fusion biopsy are desirable.. · Ullrich T, Boschheidgen M, Schweyen CM et al. Evaluation of the current status, significance, and availability of prostate MRI und MRI guided biopsy in germany. Fortschr Röntgenstr 2024; DOI 10.1055/a-2416-1343.

Prostate cancer (PCa) screening has evolved beyond PSA and digital rectal exam to include multiparametric prostate MRI (mpMRI). Incorporating this advanced imaging tool has further limited the well-established problem of overdiagnosis, aiding in the identification of higher grade, clinically significant cancers. For this reason, mpMRI has become an important part of the diagnostic pathway and is recommended across guidelines in biopsy naïve patients or for patients with prior negative biopsy. This contemporary review evaluates the most recent literature on the role of mpMRI in the screening and diagnosis of prostate cancer. Barriers to utilization of mpMRI still exist including variable access, high cost, and requisite expertise, encouraging evaluation of novel techniques such as biparametric MRI. Future screening and diagnostic practice patterns will undoubtedly evolve as our understanding of novel biomarkers and artificial intelligence improves.

This study aimed to compare the upgrade rate and cancer detection rate between the 18F-DCFPyL PET/MRI-guided ultrasound fusion targeted biopsy (TB) and systematic biopsy in selected patients with suspected prostate cancer (the molecular imaging prostate-specific membrane antigen score of ≥2 and multiparametric MRI Prostate Imaging Reporting and Data System score of ≥4).

Eighty-seven selected biopsy-naive patients were randomized into two groups: TB (n=41) and systematic biopsy (control; n=46). Patients diagnosed with clinically significant prostate cancer proceeded to radical prostatectomy. The primary outcome was the pathological upgrade rate. Secondary outcomes, including the cancer detection rate, incidence of repeat biopsy, positive surgical margin, complications, and prostate-specific antigen level at 6 weeks postoperatively, were compared between the groups using the Pearson or Fisher's exact test, as appropriate.

In the study, prostate cancer was ultimately detected in all patients. The TB group successfully identified all tumors, whereas five patients in the control group initially missed diagnosis. The pathological upgrade rates for the TB and control groups were 31.7 % and 56.5%, respectively. Overall, the detection rate for clinically significant prostate cancer (the International Society of Urological Pathology grade of ≥2) was significantly higher in the TB group (92.7%) compared with the control group (76.1%, p=0.035). However, no significant difference was found in the detection rate of all prostate cancer. Complications (Clavien-Dindo grade of ≤2) occurred in both the TB group (n=11) and control group (n=13). No statistically significant difference was observed between the groups in terms of the positive surgical margin, complications, or 6-week postoperative prostate-specific antigen level.

The 18F-DCFPyL PET/MRI-guided ultrasound fusion TB alone was an efficient modality in diagnosing selected patients with prostate cancer.

Early diagnosis and treatment of prostate cancer (PC) are crucial for effective management and improved patient outcomes. Newer imaging modalities like prostate-specific membrane antigen PET have shown superior diagnostic performance in detecting PC and clinically significant PC (csPC). This systematic review and meta-analysis aims to synthesize evidence on the diagnostic performance of PSMA PET-guided prostate biopsy in detecting PC and csPC.

The study followed the PRISMA-DTA guidelines. Using a predefined search strategy, 3 databases (PubMed, Embase, and Web of Science) were systematically searched using appropriate keywords. A meta-analysis was conducted using diagnostic accuracy parameters of the included studies. Risk of bias assessment was done using the QUADAS-2 tool.

Out of 378 articles, 20 were assessed for full-text screening and 10 articles with 874 patients were finally included. Eight studies reported a pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of 0.90 (95%confidence interval [CI], 0.82-0.95), 0.93 (95% CI, 0.57-0.99), 12.3 (95% CI, 1.5-98.9), 0.10 (95% CI, 0.05-0.20), and 117 (95% CI, 12-1178), respectively, for detecting PC using PSMA PET-guided prostate biopsy with an area under the summary receiver operating characteristics curve of 0.94 (95% CI, 0.92-0.96). Similarly, 6 studies reported a pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of 0.89 (95% CI, 0.82-0.94), 0.65 (95% CI, 0.49-0.79), 2.6 (95% CI, 1.6-4.1), 0.17 (95% CI, 0.09-0.31), and 15 (95% CI, 6-41), respectively, for detecting csPC using PSMA PET-guided prostate biopsy with area under summary receiver operating characteristics curve of 0.86 (95% CI, 0.82-0.88).

PSMA PET-guided prostate biopsy has a high diagnostic accuracy in detecting PC and csPC in patients with clinical suspicion of PC, and provides a 1-stop solution for early diagnosis and staging of PC.

The association between prostate cancer (PCa) lesion volume on multiparametric magnetic resonance imaging (mpMRI) and clinically significant PCa (csPCa) remains a poorly studied aspect of diagnostic workup in patients with suspicion of PCa. The aim of this study was to assess the diagnostic value of mpMRI lesion volume in detecting csPCa.

Patients with an elevated prostate-specific antigen (PSA) and suspicion of PCa underwent mpMRI as part of routine workup. Following this, patients underwent systematic and fusion targeted biopsy of the region of interest (ROI). All target lesions were sampled once in both axial and sagittal planes, with at least 2 cores per target. csPCa was defined as Gleason grade group ≥2, while highly suspicious lesions were considered as those with PI-RADS score ≥4. Multivariate logistic regression was performed for factors predicting csPCa.

Fifty men with a total of 108 mpMRI lesions were included, with a mean age of 71 ±6 years. 52% had prior negative biopsies. The mean lesion volume was 0.95 ±0.04 ml. Thirty-two patients (64%) had positive biopsies, among whom 20 had csPCa. Fifteen patients (30%) had highly suspicious PI-RADS lesions. Multivariate analysis demonstrated that capsular bulging, younger age, small prostate, highly suspicious lesions, high PSA density, and lesion volume >1mL were predictive of csPCa.

Lesion volume on mpMRI may be used as a non-invasive indicator of csPCa. Future studies exploring the correlation between lesion volume and csPCa may enable patients to be monitored by non-invasive means, while ensuring early intervention when needed.

The prostate biopsy (PB) results should be concordant with prostatectomy histopathology to avoid overestimating or underestimating the disease, leading to inappropriate or undertreatment of prostate cancer (PCa) patients. Since the introduction of multiparametric Magnetic Resonance Imaging (mpMRI) in the diagnostic pathway of PCa, most studies have shown that MRI/Ultrasound fusion-guided (MRI-fusion) PB improves concordance with histopathology of radical prostatectomy specimens. This study aimed to evaluate the improvement in concordance of prostatectomy specimens with PB histopathology obtained using the MRI-fusion approach compared with the 12-core TRUS-Bx and to identify the variables influencing this.

The study included 218 men who were diagnosed with PCa by PB and underwent radical prostatectomy between 2016 and 2023. The patients were grouped based on the biopsy method: 115 underwent TRUS-Bx, and 103 underwent MRI-fusion PB. The histopathological grading of these biopsy approaches was compared with that of radical prostatectomy specimens. Multivariate logistic regression analyses were conducted to evaluate the impact of various criteria on histopathological concordance.

In patients with unfavorable intermediate- and high-risk PCa, MRI-fusion PB showed significantly better concordance with prostatectomy histopathology than TRUS-Bx (73.1% vs. 42.9%, p = 0.018). MRI-fusion PB had a significantly lower downgrading of prostatectomy histopathology than TRUS-Bx in all grade categories. The number of cancer-involved regions of the prostate is an independent predictor for concordance (OR = 1.24, 95%CI = 1.04-1.52, p = 0.02) and downgrading (OR = 0.46, 95%CI = 0.24-0.83, p = 0.01).

Using an MRI-fusion PB improves histopathological concordance in patients with unfavorable intermediate and high-risk PCa. It reduces the downgrading rate of prostatectomy histopathology compared with TRUS-Bx in all grade categories. The number of cancer-involved regions is an independent predictor of the concordance between biopsy and final histopathology after prostatectomy and post-prostatectomy histopathology downgrading. Our findings could assist in selecting PCa patients for AS and focal treatment based on the histopathology obtained from the MRI-fusion PB.