ArticleUrologie (Heidelberg, Germany)2026
[Influence of MRI fusion biopsy on treatment recommendations : How reliable are biopsy results?]
Article in Urologie (Heidelberg, Germany), 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
backgroundThe detection of clinically significant prostate cancer remains a diagnostic challenge. The combination of magnetic resonance imaging (MRI) fusion biopsy and systematic biopsy is currently considered standard in primary diagnostics.
objectivesThe study examined differences in guideline-based treatment recommendations derived from the histology of MRI fusion versus systematic biopsy and their concordance with prostatectomy histology. MATERIALS AND
methodsA total of 476 patients who underwent prostate biopsy between January 2022 and December 2024 were included. Primary endpoints were histological classification by biopsy method and the resulting treatment recommendations. In a subgroup of 57 patients (115 lesions) who underwent radical prostatectomy, concordance between biopsy and surgical histology was analyzed based on Prostate Imaging Reporting and Data System (PI-RADS) scores. Statistical analyses included binomial test, McNemar's test, Cohen's κ, and binary logistic regression (significance level p < 0.05).
resultsThe combined approach detected significantly more clinically relevant cancers than systematic biopsy alone (41.7% vs. 27.9%; p < 0.001) and led to more curative treatment recommendations (36.0% vs. 26.2%; p < 0.001). Compared with MRI fusion biopsy alone, it also yielded a higher rate of curative recommendations (36.0% vs. 32.8%; p < 0.001). Concordance of Gleason scores with prostatectomy findings was highest for PI-RADS 5 lesions (κ = 0.294) and significantly higher than for PI-RADS 3 (p = 0.029).
conclusionThe combined biopsy approach increases the rate of guideline-concordant curative treatment recommendations. However, the added diagnostic value of systematic biopsy remains limited. Higher concordance between biopsy and prostatectomy histology was observed only in PI-RADS 5 lesions.
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