Prostate biopsy is regarded to be the cornerstone for the diagnosis of possible malignancy of the prostate. Historically, transrectal ultrasound and biopsy has been the most favored approach. A number of sampling schema which can range from 6 to 24 cores saturation biopsy can be considered using this technique. Further advancement in imaging technology has paved the way for early detection of prostate cancer. Artemis Fusion MRI biopsy is one of the most popular systems in the field of prostate biopsy. This imaging system biopsy improves detection by combining targeted and systematic biopsies. This study aimed to evaluate role of Artemis Fusion Biopsy in detection of Prostate cancer

Retrospective review of admitted cases from January 2019 to September 2024 in the institution for MRI-TRUS fusion biopsy was done. Patients underwent biparametric or multiparametric MRI. These cases were then reported following the PIRADS version 2. The clinical, imaging and biopsy parameters were also recorded and evaluated.

A total of 1002 cases of patients with elevated PSA requested to undergo biopsy was included. PSA levels (13.4 (8.0-26.2), PSA density (0.45; 0.2-0.9), and prostate size (32; 25-43) were significantly elevated in clinically significant cases (p. 001 < .05). The largest nodule sizes were seen in PI-RADS 5 cases (1.8; 1.3-2.5) compared to other scores (p < 0.001). Results revealed that the number of targeted cores in PIRADS 5 was significantly higher compared to those with PIRADS 3 and 4 (4.72±1.82 vs. 4.09±1.11 and 4.49±1.60; p .001 < .05). Targeted biopsy had higher detection rate across all PSA ranges than systematic biopsy (p .001 < .05). This group also yielded more positive target biopsy cores (2 vs. 0 p .001 < .05) and higher Gleason scores (3 vs. 2; p.001 < .05). Systematic biopsy core had limited diagnostic yield compared to total core biopsy (0 to 25% vs. 50 to 75% respectively; p .001 < .05).

Higher PI-RADS would yield higher number of positive target biopsy cores compared to conventional 12-core biopsy. The data also disclosed that higher PI-RADS score was significantly correlated with higher Gleason score indicative of a more progressive prostate malignancy. Targeted biopsy using Artemis fusion biopsy yielded a significantly higher cancer detection rate compared to conventional 12-core biopsy. This shows that the use of Artemis fusion biopsy in men who will undergo first time prostate biopsy is a more beneficial and efficient approach since this will generate better clinical yield enabling urologists in arriving at a more accurate and definitive diagnosis.