Enhancing Prostate Cancer Diagnosis: A Comparative Analysis of Combined Fusion and Systematic Biopsy Methods—A Single-Center Study

<b>Background/Objectives:</b> Prostate cancer is the second most prevalent malignancy in men globally, typically suspected following abnormalities found during digital rectal examination (DRE) or elevated PSA levels. This study aimed to evaluate and compare the effectiveness of two biopsy techniques-TRUS-Bx and ComBx-in detecting prostate cancer, particularly focusing on the identification of clinically significant prostate cancer (csPCa) with an International Society of Urological Pathology (ISUP) grade ≥ 2. <b>Methods:</b> This retrospective cohort study involved 500 men (aged 46 to 79, with an average age of 65) who had prostate biopsies at our institution between 2017 and 2022. The patients were divided into two groups: 250 men received a transrectal US-guided biopsy (TRUS-Bx) with a standard 12-core sampling, while the other 250 underwent a transperineal combined fusion biopsy (ComBx) with MRI guidance. The ComBx group targeted areas classified as PI-RADS ≥ 3 and also included additional systematic samples. Tumor detection rates for both techniques were assessed, with a particular focus on overall PCa detection and the identification of csPCa. <b>Results:</b> In the TRUS-Bx group, the mean PSA level was 8.2 ng/mL (1.8-45.2 ng/mL), and in the ComBx group, the mean PSA level was 7.5 ng/mL (0.8-32.4 ng/mL). ComBx demonstrated superior detection rates for PCa compared to TRUS-Bx, with statistically significant differences observed in the overall detection of PCa with ISUP grade ≥ 1 (61% for ComBx vs. 45% for TRUS-Bx; <i>p</i> < 0.001) and csPCa (40% for ComBx vs. 30% for TRUS-Bx; <i>p</i> = 0.019). In the ComBx group for csPCa, the detection rates in targeted biopsies of MRI-identified lesions assessed as PIRADS 3, 4, and 5 were 17%, 51%, and 78%, respectively. <b>Conclusions:</b> ComBx offers significantly improved efficacy in detecting prostate cancer, particularly in identifying clinically significant cases, compared to systematic TRUS-Bx. These findings support ComBx as a valuable tool in enhancing diagnostic accuracy for csPCa.