A systematic review of guided biopsy in the primary diagnosis of prostate cancer

Introduction. Prostate cancer is the second most commonly diagnosed malignancy among men, with an increasing incidence of early-stage disease detection over recent decades. Accurate diagnosis remains crucial, particularly in distinguishing clinically significant cancers from indolent tumors, thus avoiding overtreatment and unnecessary complications. The introduction of multiparametric magnetic resonance imaging (mpMRI) targeted fusion biopsy represents a significant advancement in diagnostic pathways; however, there is ongoing debate regarding its superiority over traditional systematic biopsy (SBx). Material and methods. A narrative literature review was conducted using PubMed and Elsevier (ScienceDirect) databases, supplemented by current European Association of Urology guidelines from March 2025. From an initial search yielding 451 articles, 32 were evaluated in-depth, and ultimately nine studies were selected for detailed analysis. Data regarding diagnostic yield, clinical significance of detected cancers, cost-effectiveness, biopsy accuracy, and overall healthcare implications were extracted. Results. Magnetic resonance imaging targeted fusion biopsy demonstrated superior detection of clinically significant prostate cancer compared with systematic biopsy in several studies. Notably, targeted biopsies (TBx) identified fewer cases of clinically insignificant disease, thereby reducing the risk of overtreatment. However, meta-analyses revealed variability in outcomes, with certain studies reporting no significant difference in overall cancer detection rates between fusion and SBx. Economic analyses indicated that mpMRI-targeted approaches reduced healthcare costs through decreased unnecessary procedures. Furthermore, studies evaluating biopsy core proximity to MRI-visible lesions emphasized improved diagnostic accuracy with targeted sampling. Discussion. Current literature highlights ongoing discrepancies in the comparative effectiveness of fusion and SBx methods, influenced by methodologic variations, patient selection criteria, and biopsy technique differences. Although TBx consistently shows benefits in detecting clinically significant cancers, definitive evidence correlating biopsy outcomes to final histopathology following prostatectomy remains limited. Additional high-quality studies are required to confirm the true clinical advantage of fusion biopsy and establish its role in standard clinical practice. Conclusions. Magnetic resonance imaging targeted fusion biopsy offers clear advantages in identifying clinically significant prostate cancer and minimizing overtreatment compared to traditional SBx. Despite this, variability in results and the lack of robust correlation with final pathologic outcomes underline the necessity for further prospective research. Continued investigation is essential to refine biopsy strategies, improve diagnostic accuracy, and optimize healthcare resource utilization in prostate cancer management.