Background/Objectives: This study analyzed the impact of operator experience on the detection of PC and csPC using a standardized MRI/TRUS-fusion biopsy protocol in an experienced high-volume center.Methods: Men with mpMRI and subsequent combined TB and SB (2019–2024) using transrectal, software-assisted MRI/TRUS-fusion were retrospectively included. Operators were stratified by experience subgroups (<100 vs. ≥100 procedures). Clinical, MRI, and biopsy data have been assessed. The primary objective was the analysis of the effect of biopsy experience on patient-level PC detection. The secondary objective was the PC detection of PI-RADS and DRE.Results: A total of 683 consecutive patients were included (median age 63 years, median PSA 6.5 ng/mL, and median prostate volume 41 mL). Overall, PC and csPC detection were 67% and 51%, with no significant difference in the operator experience subgroups (p= 0.63;p= 0.23). There were no significant differences for additional csPC detection by SB (7% vs. 5%;p= 0.31) or TB (9% vs. 10%;p= 0.93) in both subgroups. DRE showed limited diagnostic value (SEN 32%, SPE 88%, PPV 74%, NPV 55%) with no significant variation regarding the experience (p= 0.12–1.0). Limitations include a single-center, retrospective design and a lack of a radical prostatectomy specimen.Conclusions: In a standardized MRI-targeted biopsy setting, operator experience seems to have a lower influence on PC or csPC detection. High csPC detection in PI-RADS 4–5 supports a TB-only approach, while low rates in PI-RADS 3 suggest follow-up MRI over immediate biopsy. Limited DRE accuracy highlights its declining role in PC assessment.
背景/目的：本研究旨在分析在经验丰富的高手术量中心，采用标准化MRI/TRUS融合活检方案时，操作者经验对前列腺癌（PC）及临床显著性前列腺癌（csPC）检出率的影响。方法：回顾性纳入2019年至2024年间接受多参数MRI检查，并随后经直肠、软件辅助MRI/TRUS融合靶向活检（TB）联合系统活检（SB）的男性患者。根据操作者经验进行分层（<100例 vs. ≥100例）。对临床、MRI及活检数据进行了评估。主要目的是分析活检经验对患者层面PC检出率的影响。次要目的是评估PI-RADS评分及直肠指检（DRE）对PC的检出效能。结果：共纳入683例连续患者（中位年龄63岁，中位PSA 6.5 ng/mL，中位前列腺体积41 mL）。总体PC和csPC检出率分别为67%和51%，不同操作者经验亚组间无显著差异（p=0.63；p=0.23）。在两个亚组中，SB（7% vs. 5%；p=0.31）或TB（9% vs. 10%；p=0.93）对额外csPC的检出率也无显著差异。DRE的诊断价值有限（敏感性32%，特异性88%，阳性预测值74%，阴性预测值55%），且其诊断效能不随操作者经验变化而出现显著差异（p=0.12–1.0）。研究的局限性包括单中心、回顾性设计以及缺乏根治性前列腺切除术标本。结论：在标准化的MRI靶向活检背景下，操作者经验对PC或csPC检出率的影响似乎较低。PI-RADS 4–5分患者中csPC检出率高，支持仅行TB的策略；而PI-RADS 3分患者检出率低，提示应优先选择MRI随访而非立即活检。DRE准确性有限，凸显了其在PC评估中的作用正在减弱。
Analysis of Operator Expertise in MRI/TRUS Fusion-Guided Prostate Biopsy
肿瘤(癌症)患者之家