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Background <p>The detection of clinically significant prostate cancer remains a&#xa0;diagnostic challenge. The combination of magnetic resonance imaging (MRI) fusion biopsy and systematic biopsy is currently considered standard in primary diagnostics.</p> Objectives <p>The study examined differences in guideline-based treatment recommendations derived from the histology of MRI fusion versus systematic biopsy and their concordance with prostatectomy histology.</p> Materials and methods <p>A&#xa0;total of 476 patients who underwent prostate biopsy between January 2022 and December 2024 were included. Primary endpoints were histological classification by biopsy method and the resulting treatment recommendations. In a&#xa0;subgroup of 57&#xa0;patients (115 lesions) who underwent radical prostatectomy, concordance between biopsy and surgical histology was analyzed based on Prostate Imaging Reporting and Data System (PI-RADS) scores. Statistical analyses included binomial test, McNemar’s test, Cohen’s&#xa0;κ, and binary logistic regression (significance level&#xa0;<i>p</i> &lt; 0.05).</p> Results <p>The combined approach detected significantly more clinically relevant cancers than systematic biopsy alone (41.7% vs. 27.9%; <i>p</i> &lt; 0.001) and led to more curative treatment recommendations (36.0% vs. 26.2%; <i>p</i> &lt; 0.001). Compared with MRI fusion biopsy alone, it also yielded a&#xa0;higher rate of curative recommendations (36.0% vs. 32.8%; <i>p</i> &lt; 0.001). Concordance of Gleason scores with prostatectomy findings was highest for PI-RADS&#xa0;5 lesions (κ = 0.294) and significantly higher than for PI-RADS&#xa0;3 (<i>p</i> = 0.029).</p> Conclusion <p>The combined biopsy approach increases the rate of guideline-concordant curative treatment recommendations. However, the added diagnostic value of systematic biopsy remains limited. Higher concordance between biopsy and prostatectomy histology was observed only in PI-RADS&#xa0;5&#xa0;lesions.</p>

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Einfluss der MRT-Fusionsbiopsie auf Therapieempfehlungen

  • 期刊论文

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  • 发表日期：

    2025年12月9日

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  • P. Schildhauer,
  • M. Müller,
  • A. S. Merseburger,
  • S. M. Weiler,
  • A. Fürschke,
  • Y. Elser,
  • A. Moderegger,
  • H. E. Fender

摘要

Background

The detection of clinically significant prostate cancer remains a diagnostic challenge. The combination of magnetic resonance imaging (MRI) fusion biopsy and systematic biopsy is currently considered standard in primary diagnostics.

Objectives

The study examined differences in guideline-based treatment recommendations derived from the histology of MRI fusion versus systematic biopsy and their concordance with prostatectomy histology.

Materials and methods

A total of 476 patients who underwent prostate biopsy between January 2022 and December 2024 were included. Primary endpoints were histological classification by biopsy method and the resulting treatment recommendations. In a subgroup of 57 patients (115 lesions) who underwent radical prostatectomy, concordance between biopsy and surgical histology was analyzed based on Prostate Imaging Reporting and Data System (PI-RADS) scores. Statistical analyses included binomial test, McNemar’s test, Cohen’s κ, and binary logistic regression (significance level p < 0.05).

Results

The combined approach detected significantly more clinically relevant cancers than systematic biopsy alone (41.7% vs. 27.9%; p < 0.001) and led to more curative treatment recommendations (36.0% vs. 26.2%; p < 0.001). Compared with MRI fusion biopsy alone, it also yielded a higher rate of curative recommendations (36.0% vs. 32.8%; p < 0.001). Concordance of Gleason scores with prostatectomy findings was highest for PI-RADS 5 lesions (κ = 0.294) and significantly higher than for PI-RADS 3 (p = 0.029).

Conclusion

The combined biopsy approach increases the rate of guideline-concordant curative treatment recommendations. However, the added diagnostic value of systematic biopsy remains limited. Higher concordance between biopsy and prostatectomy histology was observed only in PI-RADS 5 lesions.