Comparison of cognitive fusion and standard prostate biopsy after multiparametric prostate magnetic resonance imaging and place of multiparametric prostate magnetic resonance imaging in diagnosis.

Objectives: To compare the diagnostic performance of cognitive fusion biopsy and/or standard systematic biopsy performed following multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer (PCa), and to assess the standalone diagnostic value of mpMRI.

Materials and methods: Initially, 1153 patients undergoing PBx from 2017 to 2022 were chosen. Patients were divided into three groups: those with standard PBx without mpMRI (1st group), those with standard PBx after mpMRI (2nd group) and those with standard and cognitive fusion PBx after mpMRI (3rd group). The correlations of general PCa and clinically significant PCa (csPCa) detection rates and Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) scores were evaluated.

Results: The overall PCa detection rate was highest in group 2 (47%). Additionally, the malignancy rate in group 3 was significantly higher compared to group 1 (P < .05). Though the csPCa rate was higher in the third group (40%) compared to the other groups, no significant difference was identified. As the PI-RADS score increased, the malignancy rates appeared to increase. The rate of high-risk patients in the group with cognitive fusion biopsy performed (11, 17%) was higher compared to the second group (P < .05).

Conclusions: Multiparametric MRI is valuable in prostate cancer diagnosis, particularly for lesion detection and biopsy guidance in patients with high PI-RADS scores. However, in our study, the addition of cognitive fusion biopsy did not significantly increase the detection rate of csPCa. Further prospective randomized studies are needed to clarify its diagnostic value.