Background/Objectives: Magnetic resonance imaging (MRI) and MRI–ultrasound (US) fusion-targeted biopsy have improved prostate cancer diagnosis, particularly for clinically significant disease. However, the added value of combining systematic biopsy with targeted biopsy remains debated. This study aimed to evaluate the diagnostic accuracy of MRI–US fusion-targeted and systematic transperineal biopsies in detecting prostate cancer and explore the correlation between PI-RADS score and histology.Methods: We retrospectively analyzed 356 patients with 452 MRI-detected lesions who underwent both MRI–US fusion-targeted and transperineal systematic biopsies between 2020 and 2023. Clinically significant prostate cancer (csPCa) was defined as International Society of Urological Pathology (ISUP) grade ≥ 2. Diagnostic performance metrics (sensitivity, specificity, and accuracy) were calculated for each technique using the combined result as a reference. Subgroup analysis was performed for patients under active surveillance.Results: Prostate cancer was diagnosed in 323 of 452 lesions (71%) and csPCa in 223 lesions (49%). Targeted biopsy demonstrated higher sensitivity (93.7%) and accuracy (79.9%) than systematic biopsy (85.7% sensitivity and 77.6% accuracy), although systematic biopsy provided slightly higher specificity. Systematic biopsy alone identified 8.2% of PCa cases missed by targeted biopsy and upgraded 9.9% of lesions to csPCa. csPCa detection increased with PI-RADS score (23% in PI-RADS 3 and 73% in PI-RADS 5). In active surveillance patients, csPCa was found in 65% of lesions.Conclusions: MRI–US fusion-targeted biopsy improves csPCa detection, but systematic biopsy remains valuable, especially for identifying additional or higher-grade disease. The combined approach provides an optimal diagnostic yield, supporting its continued use in both initial and repeat biopsy settings.
**背景/目的：** 磁共振成像（MRI）及MRI-超声（US）融合靶向活检技术提升了前列腺癌的诊断水平，尤其对于具有临床意义的肿瘤。然而，系统活检与靶向活检联合应用是否具有额外价值仍存争议。本研究旨在评估MRI-US融合靶向活检与经会阴系统活检在前列腺癌检出中的诊断准确性，并探讨PI-RADS评分与组织病理学结果之间的相关性。 **方法：** 我们回顾性分析了2020年至2023年间接受MRI-US融合靶向活检和经会阴系统活检的356例患者，共452个MRI检出病灶。将国际泌尿病理学会（ISUP）分级≥2级定义为具有临床意义的前列腺癌（csPCa）。以两种活检方法的联合结果为参考标准，计算每种技术的诊断性能指标（敏感性、特异性、准确性）。并对主动监测患者进行了亚组分析。 **结果：** 在452个病灶中，323个（71%）诊断为前列腺癌，其中223个（49%）为csPCa。与系统活检（敏感性85.7%，准确性77.6%）相比，靶向活检显示出更高的敏感性（93.7%）和准确性（79.9%），尽管系统活检的特异性略高。单独使用系统活检发现了8.2%被靶向活检漏诊的PCa病例，并使9.9%的病灶升级为csPCa。csPCa检出率随PI-RADS评分升高而增加（PI-RADS 3为23%，PI-RADS 5为73%）。在主动监测患者中，65%的病灶检出csPCa。 **结论：** MRI-US融合靶向活检提高了csPCa的检出率，但系统活检仍具价值，特别是在发现额外病灶或更高分级肿瘤方面。联合应用两种方法可获得最佳的诊断效能，支持其在初次及重复活检场景中继续使用。
肿瘤(癌症)患者之家