The clinical significance of pre-biopsy MRI and PI-RADS v2 in detecting clinically significant prostate cancer (CSPCa) in patients with elevated PSA is widely recognized. Our institution has been performing MRI-TRUS fusion prostate biopsy since April 2017 and has accumulated experience with over 1800 cases by February 2024. This study aims to evaluate the CSPCa detection rate of MRI-TRUS fusion biopsy compared to our historical conventional biopsy method.

We retrospectively analyzed 268 MRI-TRUS fusion biopsies (August 2021 - July 2022). The Gleason Grade Group (GG) 2-5 cancer detection rate (targeted + systematic) was assessed and compared to 485 conventional 12-core biopsies performed throughout the year 2015 (no prior MRI). Statistical analysis was performed using EZR (a graphical user interface for R), with p < 0.05 considered significant. The CSPCa (GG ≥ 2) detection rates of the two methods were statistically compared.

The overall detection rate of GG 2-5 cancer in the MRI-TRUS fusion biopsy group (n=268) was 82.5% (221/268). In the conventional biopsy group (n=485), the detection rate of GG 2-5 cancer was 34.6% (168/485). The MRI-TRUS fusion biopsy demonstrated a significantly higher CSPCa detection rate compared to the conventional method (p<0.001).

Pre-biopsy MRI with PI-RADS assessment and MRI-TRUS fusion prostate biopsy achieve a significantly higher cancer detection rate compared to the conventional systematic biopsy approach. This improved detection rate may contribute to reducing unnecessary prostate biopsies and facilitating more accurate diagnosis of clinically significant prostate cancer.