Background Multiparametric magnetic resonance imaging (MRI)-targeted biopsy has improved prostate cancer detection, yet the relative diagnostic contributions of MRI fusion-targeted biopsy and systematic transrectal ultrasound-guided (TRUS) biopsy across prostate-specific antigen (PSA) and PSA density (PSAD) levels remain uncertain. We evaluated the incremental detection of clinically significant prostate cancer (csPCa) between these techniques. Methods This retrospective single-center paired cohort study included 376 men with biopsy-proven prostate cancer who underwent both MRI fusion-targeted and 12-core systematic TRUS biopsy in the same session for a PI-RADS ≥3 lesion. csPCa was defined as ISUP Grade Group ≥2. Detection was compared overall and across PSA strata (50 ng/mL) and PSAD groups (<0.10, 0.10–<0.15, ≥0.15 ng/mL/cc) using exact McNemar testing on discordant pairs. Results Overall prostate cancer detection was similar between MRI fusion-targeted and systematic TRUS biopsy (318/376, 84.6% vs 316/376, 84.0%; p=0.927). csPCa was detected in 226/376 patients (60.1%) by MRI fusion-targeted biopsy and 212/376 (56.4%) by systematic biopsy; 60 MRI-only and 46 systematic-only discordant cases were observed (p=0.206). MRI fusion-targeted biopsy showed numerically higher csPCa detection across the intermediate PSA range (4–50 ng/mL), with the largest absolute difference of 9.1 percentage points at PSA 20.01–50 ng/mL (n=33); no PSA-stratified comparison reached statistical significance. csPCa detection increased with PSAD for both techniques across all three PSAD strata. Conclusion MRI fusion-targeted and systematic TRUS biopsies were complementary for csPCa detection. MRI fusion-targeted biopsy showed a numerical advantage in the intermediate PSA range, while csPCa detection increased with PSA density for both techniques. These findings support risk-stratified interpretation of biopsy yield and do not support routine omission of systematic cores when MRI fusion-targeted biopsy is performed.
Visuthikosol et al. (Mon,) studied this question.
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