Prostate cancer is a leading malignancy among men in Thailand, often progressing without distinct symptoms. Traditional diagnostic methods such as transrectal ultrasound (TRUS)-guided biopsy can result in underdiagnosis or unnecessary sampling due to limited lesion targeting. MRI-ultrasound fusion biopsy, utilizing pre-procedural MRI to identify suspicious lesions, is increasingly recognized for its improved diagnostic accuracy. This study evaluates and compares these two techniques to assess cancer detection efficiency and post-procedural outcomes in a clinical setting at Taksin Hospital.

This retrospective cohort study included 74 male patients who underwent prostate biopsy between October 1, 2021, and September 30, 2024, at Taksin Hospital. Participants had elevated PSA levels and/or abnormal digital rectal examinations. Patients were excluded if they had PSA > 100 ng/mL, metastatic disease, or adjacent organ invasion. Subjects were divided into: Group A (TRUS biopsy): 55 patients Group B (MRI-ultrasound fusion biopsy): 19 patients Data from electronic medical records were used to analyze detection rates and post-biopsy complications. Statistical analysis was performed using Pearson’s chi-squared test.

The MRI-ultrasound fusion group demonstrated a significantly higher prostate cancer detection rate (73.7%) compared to the TRUS group (34.5%) (p = 0.003). Gleason grading showed similar distributions across both groups, but the MRI-fusion method identified more low-grade cancers, suggesting earlier-stage detection. Complication rates were lower in the MRI-fusion group. The TRUS group experienced: Acute urinary retention (2 cases), Hematuria (8 cases), Post-biopsy fever (10 cases), including 1 with sepsis from ESBL-producing E. coli. In contrast, the MRI-fusion group had fewer instances of hematuria (2 cases) and fever (2 cases), with no severe infections.

MRI-ultrasound fusion biopsy offers a significantly higher detection rate of prostate cancer with fewer complications compared to conventional TRUS biopsy. While it incurs higher costs, its diagnostic accuracy and safety profile support its integration into clinical practice. Cost-benefit analyses and prospective trials are warranted to confirm its long-term value and feasibility in broader healthcare settings.