Comparison of cognitive magnetic resonance-ultrasonography fusion prostate biopsy outcomes in left lateral decubitus vs lithotomy positions: a prospective randomized study cognitive magnetic resonance-ultrasonography fusion prostate biopsy.

Abstract

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

Methods: 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.

Results: 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).

Conclusions: 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.