Comparison of prostate cancer detection rates of anterior versus posterior MRI targets in transrectal MRI/transrectal ultrasound fusion biopsy—Experience of 1300 patients

Objective Prostate biopsy remains essential for diagnosing prostate cancer (PCa), as histological examination is irreplaceable. Fusion biopsy, combining systematic and targeted approaches, enhances cancer detection rates. However, lesions in the anterior prostate remain a diagnostic challenge due to their inaccessibility via digital rectal examination and limitations of standard biopsy protocols. This study aimed to evaluate PCa detection rates based on lesion localization and the diagnostic performance of MRI-ultrasound fusion biopsy in different prostate regions. Methods This retrospective study included 1300 patients with 2000 suspicious MRI lesions, all undergoing transrectal MRI-ultrasound fusion biopsy between August 2014 and December 2023. The fusion was performed elastically using an organ-based, non-rigid registration approach implemented on the Koelis Platform (Koelis®). Lesions were categorized into three groups: anterior fibromuscular stroma (AFMS), anterior transitional zone, and posterior zone. Detection rates were analyzed based on location and PI-RADS scores. Univariable and multivariable logistic regression analyses were performed to assess potential biases. Results A total of 1196 patients and 2002 Prostate Imaging Reporting and Data System (PI-RADS) category ≥3 lesions were included. The overall PCa detection rate was 55%, with clinically significant prostate cancer (csPCa) detected in 32% of lesions. Detection rates were highest in the posterior zone (59%) and the AFMS (58%)—both significantly higher than in the anterior transitional zone (50%) ( p =0.005 and p =0.009, respectively). csPCa detection rates were highest in AFMS (40%) and posterior zone (36%). Stratified by PI-RADS, detection rates were 80% for PI-RADS category 5, 63% for PI-RADS category 4, and 40% for PI-RADS category 3. Conclusion Lesion localization on mpMRI significantly affects PCa detection through biopsy, emphasizing the need to consider lesion location in patient counseling and clinical decision-making.