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Objective <p>Systematic biopsy (SBx) underdetects clinically significant prostate cancer and overdiagnoses indolent disease. This study compared the transperineal cognitive fusion targeted biopsy (COG-TBx)—which uses multiparametric MRI for precision—against SBx, evaluating their cancer detection rates and safety profiles in a clinical cohort.</p> Methods <p>A total of 360 patients undergoing transperineal prostate biopsy were included, with 161 assigned to the COG-TBx group and 199 to the SBx group. Primary outcomes included PCa detection, csPCa (defined as Gleason score ≥ 3 + 4 or ISUP Level ≥ 2), and 30-day complication rates. Secondary outcomes comprised cancer detection rate per core and pathological characteristics. Statistical analyses involved χ² tests, t-tests, and multivariable logistic regression.</p> Results <p>Baseline characteristics were comparable between groups, though prostate volume was larger in the COG-TBx group (52.0&#xa0;ml vs. 46.0 ml, <i>P</i> = 0.024). The COG-TBx group demonstrated significantly higher PCa (52.2% vs. 41.2%, <i>P</i> = 0.034) and csPCa detection rates (44.7% vs. 25.6%, <i>P</i> &lt; 0.05), as well as a higher cancer detection rate per needle (28.5% vs. 19.3%, <i>P</i> = 0.003). The overall 30-day complication rate was slightly higher in the COG-TBx group (13.0% vs. 7.0%, <i>P</i> &gt; 0.05), without statistical significance. Multivariate analysis identified COG-TBx (OR = 1.98, 95% CI: 1.15–3.41, <i>P</i> = 0.013) and PSA level (OR = 1.12 per ng/mL, 95% CI: 1.03–1.22, <i>P</i> = 0.008) as independent predictors of csPCa detection.</p> Conclusion <p>Transperineal COG-TBx is associated with higher detection rates for prostate cancer and clinically significant cancer compared to SBx. Although associated with a slightly higher complication rate, the difference was not significant. The overall benefit supports the clinical adoption of COG-TBx.</p>

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Transperineal cognitive fusion MRI-targeted biopsy shows higher detection rates than systematic biopsy in prostate cancer: a prospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月19日

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  • Jifei Jiang,
  • Kun Wang,
  • Xiao Xie,
  • Xiaomin Mo,
  • Zehui Fu,
  • Qing Wang,
  • Feng Qian

摘要

Objective

Systematic biopsy (SBx) underdetects clinically significant prostate cancer and overdiagnoses indolent disease. This study compared the transperineal cognitive fusion targeted biopsy (COG-TBx)—which uses multiparametric MRI for precision—against SBx, evaluating their cancer detection rates and safety profiles in a clinical cohort.

Methods

A total of 360 patients undergoing transperineal prostate biopsy were included, with 161 assigned to the COG-TBx group and 199 to the SBx group. Primary outcomes included PCa detection, csPCa (defined as Gleason score ≥ 3 + 4 or ISUP Level ≥ 2), and 30-day complication rates. Secondary outcomes comprised cancer detection rate per core and pathological characteristics. Statistical analyses involved χ² tests, t-tests, and multivariable logistic regression.

Results

Baseline characteristics were comparable between groups, though prostate volume was larger in the COG-TBx group (52.0 ml vs. 46.0 ml, P = 0.024). The COG-TBx group demonstrated significantly higher PCa (52.2% vs. 41.2%, P = 0.034) and csPCa detection rates (44.7% vs. 25.6%, P < 0.05), as well as a higher cancer detection rate per needle (28.5% vs. 19.3%, P = 0.003). The overall 30-day complication rate was slightly higher in the COG-TBx group (13.0% vs. 7.0%, P > 0.05), without statistical significance. Multivariate analysis identified COG-TBx (OR = 1.98, 95% CI: 1.15–3.41, P = 0.013) and PSA level (OR = 1.12 per ng/mL, 95% CI: 1.03–1.22, P = 0.008) as independent predictors of csPCa detection.

Conclusion

Transperineal COG-TBx is associated with higher detection rates for prostate cancer and clinically significant cancer compared to SBx. Although associated with a slightly higher complication rate, the difference was not significant. The overall benefit supports the clinical adoption of COG-TBx.