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

IF 4 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International Pub Date : 2026-09-01 Epub Date: 2026-06-17 DOI:10.1016/j.prnil.2026.06.003

Thanakrit Visuthikosol, Wit Viseshsindh

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引用次数: 0

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 Prostate Imaging Reporting and Data System ≥3 lesion. csPCa was defined as International Society of Urological Pathology Grade Group ≥2. Detection was compared overall and across PSA strata (<4, 4–10, 10.01–20, 20.01–50, >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.

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通过磁共振成像融合靶向和系统经直肠超声引导活检补充检测临床意义重大的前列腺癌：回顾性配对队列中前列腺特异性抗原和前列腺特异性抗原密度的影响

多参数磁共振成像（MRI）靶向活检改善了前列腺癌的检测，但MRI融合靶向活检和系统经直肠超声引导（TRUS）活检在前列腺特异性抗原（PSA）和PSA密度（PSAD）水平上的相对诊断贡献仍然不确定。我们评估了这些技术之间临床显著性前列腺癌（csPCa）的增量检测。方法：这项回顾性单中心配对队列研究纳入了376名活检证实的前列腺癌患者，他们在同一时段接受了MRI融合靶向活检和12核系统TRUS活检，检查前列腺影像学报告和数据系统≥3个病变。csPCa定义为国际泌尿病理学会分级组≥2级。采用精确的McNemar检测对不一致对进行检测，比较整体和PSA各层（<4, 4 - 10, 10.01-20, 20.01-50, >50 ng/mL）和PSAD组（<0.10, 0.10 -<0.15,≥0.15 ng/mL/cc）的检测结果。结果MRI融合活检与系统TRUS活检的前列腺癌检出率基本一致（318/376,84.6% vs. 316/376, 84.0%; P = 0.927）。MRI融合活检226/376例（60.1%）、系统活检212/376例（56.4%）检出csPCa；单纯mri不一致病例60例，系统性不一致病例46例（P = 0.206）。MRI融合靶向活检显示csPCa在中间PSA范围（4-50 ng/mL）的检出率较高，PSA 20.01-50 ng/mL的绝对差异最大，为9.1个百分点（n = 33）；psa分层比较无统计学意义。在所有三个PSAD层中，两种技术的csPCa检测都随着PSAD的增加而增加。结论mri融合靶向和系统TRUS活检是csPCa检测的补充。MRI融合靶向活检在中等PSA范围内显示出数值优势，而两种技术的csPCa检测随PSA密度的增加而增加。这些发现支持对活检结果的风险分层解释，不支持在进行mri融合靶向活检时常规遗漏系统核心。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Prostate International Medicine-Urology

CiteScore

4.40

自引率

26.70%

发文量

审稿时长

35 days

期刊介绍： Prostate International (Prostate Int, PI), the official English-language journal of Asian Pacific Prostate Society (APPS), is an international peer-reviewed academic journal dedicated to basic and clinical studies on prostate cancer, benign prostatic hyperplasia, prostatitis, and ...