Predictors for clinically significant prostate cancer detection: Insights from transperineal software-assisted fusion biopsy and transperineal cognitive fusion biopsy

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Purpose: To compare the effectiveness of transperineal software-assisted fusion biopsy (TSAFB) and transperineal cognitive fusion biopsy (TCFB) in identifying predictors for detecting clinically significant prostate cancer (csPCa). Materials and methods: Conducted from December 2022 to December 2023 at a single center, this retrospective cohort study included male patients with prostate-specific antigen levels >4 ng/mL or positive digital rectal examination findings and suspicious lesions on multiparametric magnetic resonance imaging (MRI) (Prostate Imaging and Reporting Data System ≥3). The study compared TSAFB using the KOELIS Trinity MRI TPUS Biopsy System with TCFB. The primary outcome was the detection rate of csPCa. Secondary outcomes included the detection rate of clinically insignificant prostate cancer (cisPCa) and the overall detection rate combining csPCa and cisPCa. Results: The study analyzed 31 TSAFB and 17 TCFB procedures. Baseline demographic and clinical parameters showed no significant differences between the cohorts. TSAFB had higher median total and targeted core counts. Both TSAFB and TCFB demonstrated similar detection rates for prostate cancer, csPCa, and cisPCa. Adopting a targeted-only strategy with TCFB led to nearly 20% of cancers going undetected. Logistic regression identified prostate-specific antigen density >15% and lesion/prostate ratio as significant predictors for csPCa detection. Conclusion: TSAFB and TCFB are comparably effective in detecting csPCa. Prostate-specific antigen density >15% and lesion/prostate ratio as strong predictors for csPCa detection highlights the importance of high-quality imaging modalities such as 3T MRI for precise volume measurements of the prostate and lesions. Nevertheless, the study underscores the critical importance of incorporating systematic biopsies in TCFB to avoid missing prostate cancer cases.