MRI–超音波融合切片改善臨床顯著前列腺癌之檢出率：

單一醫學中心之比較研究

游家豪¹、林雍偉^1,2

¹ 臺北市立萬芳醫院泌尿科-委託臺北醫學大學辦理

² 臺北醫學大學泌尿學科

MRI–Ultrasound Fusion Biopsy Improves Detection of Clinically Significant Prostate Cancer: A Comparative Single-Center Study

Chia-Hao, You¹, Yung-Wei, Lin^1,2

¹ Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

² Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

Purpose:

While MRI–ultrasound fusion biopsy is increasingly adopted, its added clinical value over conventional systematic biopsy remains controversial. We aimed to determine whether fusion biopsy improves detection of clinically significant prostate cancer rather than overall cancer detection.

Materials and Methods:

We retrospectively analyzed 187 patients undergoing prostate biopsy, including 59 patients with MRI–ultrasound fusion biopsy and 128 with conventional TRUS or transperineal biopsy. Cancer detection rates, predictors of malignancy, and ISUP grade distributions were compared. Within the fusion cohort, paired analysis between targeted and systematic cores was performed. Subgroup analyses were conducted based on PI-RADS score and PSA levels.

Results:

Overall cancer detection rates were comparable between fusion and conventional biopsy (49% vs 53%). However, MRI findings strongly stratified risk, with detection rates increasing to 90.9% in PI-RADS 5 lesions. PSA density was a significant adjunct predictor.

Critically, fusion biopsy demonstrated a clear advantage in tumor grading. Targeted cores yielded significantly higher ISUP grades compared to systematic cores (3.2 ± 1.2 vs 2.4 ± 1.1, p = 0.008), indicating improved detection of clinically significant disease. In patients with PSA 4–10 ng/mL, fusion biopsy showed a trend toward higher detection rates and higher-grade tumors. At higher PSA levels, detection rates between modalities converged, suggesting reduced incremental benefit.

Conclusion:

Fusion biopsy does not increase overall cancer detection but significantly enhances identification of higher-grade prostate cancer. Its clinical benefit is most evident in intermediate-risk patients, supporting its role in improving diagnostic accuracy and reducing undergrading.