ArticleUrologic oncology2026
Transperineal 3T MRI-guided and transrectal MRI-ultrasound fusion prostate biopsies: Do lesion location and size impact diagnostic yield?
Article in Urologic oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectiveMagnetic resonance imaging (MRI)-targeted biopsies for prostate cancer diagnosis can be performed as a transperineal biopsy (TP-Bx), yet its comparative performance with transrectal biopsy (TR-Bx) remains uncertain. We evaluated the detection of clinically significant prostate cancer (csPCa) by TP-Bx and TR-Bx according to lesion size and location using Prostate Imaging Reporting & Data System (PI-RADS) criteria.
methodsWe retrospectively reviewed biopsy-naïve patients who underwent MRI-guided prostate biopsies at our institution. TR-Bx was performed using MRI-ultrasound fusion in the urology clinic, while TP-Bx utilized an MRI in-bore technique in the radiology department. Lesions were stratified by PI-RADS-defined score, location, and size.
resultsAmong 200 patients (100 TP-Bx, 100 TR-Bx), 276 PI-RADS score 3 to 5 lesions were biopsied (141 TP-Bx, 135 TR-Bx). Overall csPCa detection did not differ significantly between TP-Bx and TR-Bx (28% vs. 38%; OR = 1.5, CI = 0.9-2.6, P = 0.12). However, TR-Bx detected significantly more csPCa in non-apical peripheral zone (PZ) lesions compared to TP-Bx [45% (36/80) vs. 29% (21/73), adjusted OR = 4.6, 95% CI = 1.29-16.4, P = 0.019], particularly for small (diameter ≤1 cm) lesions (35% [16/46] vs. 12% [5/42], adjusted OR = 8.06, 95% CI = 1.45-44.7, P = 0.017). No significant difference was observed for larger lesions (diameter >1 cm).
conclusionsOverall csPCa detection rates were comparable between TP-Bx and TR-Bx, with no statistically significant difference. However, TR-Bx demonstrated superior detection in small non-apical PZ lesions, suggesting an anatomic and size-dependent advantage. These exploratory findings support further prospective studies to refine MRI-targeted biopsy protocols using PI-RADS-defined lesion characteristics to inform personalized biopsy strategies.
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