Analysis of Operator Expertise in MRI/TRUS Fusion-Guided Prostate Biopsy

<b>Background/Objectives</b>: 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. <b>Methods</b>: 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. <b>Results</b>: 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 (<i>p</i> = 0.63; <i>p</i> = 0.23). There were no significant differences for additional csPC detection by SB (7% vs. 5%; <i>p</i> = 0.31) or TB (9% vs. 10%; <i>p</i> = 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 (<i>p</i> = 0.12-1.0). Limitations include a single-center, retrospective design and a lack of a radical prostatectomy specimen. <b>Conclusions</b>: 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.