What question did this study set out to answer?

Evaluate the combined effectiveness of MRI fusion-targeted and systematic TRUS biopsy techniques in detecting clinically significant prostate cancer across different PSA and PSAD levels.

June 20, 2026Open Access

Complementary Detection of Clinically Significant Prostate Cancer by Magnetic Resonance Imaging Fusion-Targeted and Systematic Transrectal Ultrasound-Guided Biopsy: Influence of Prostate-Specific Antigen and Prostate-Specific Antigen Density in a Retrospective Paired Cohort

Key Points

Evaluate the combined effectiveness of MRI fusion-targeted and systematic TRUS biopsy techniques in detecting clinically significant prostate cancer across different PSA and PSAD levels.
Retrospective paired cohort study of 376 men with biopsy-proven prostate cancer
Both MRI fusion-targeted and systematic TRUS biopsy performed in the same session for PI-RADS ≥3 lesions
Detection rates of clinically significant prostate cancer compared using exact McNemar testing.
Overall detection rates were similar (84.6% for MRI vs 84.0% for TRUS, p=0.927)
MRI detected clinically significant prostate cancer in 60 cases not found by TRUS, while TRUS found 46 not detected by MRI (p=0.206)
Detection increased with PSAD for both techniques across all strata.

Abstract

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.

Read Full Paperexternally

Bookmark

View Full Paper

Cite This Study

Visuthikosol et al. (Mon,) studied this question.

synapsesocial.com/papers/6a362e62db0793dc1a536293 https://doi.org/https://doi.org/10.1016/j.prnil.2026.06.003

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

Bookmark

View Full Paper