A retrospective study comparing multimodal fusion biopsy and conventional cognitive fusion biopsy for diagnosing prostate cancer

Cognitive fusion targeted biopsy (cTB) is widely used in clinical practice. To advance beyond cTB, we developed a multimodal fusion targeted biopsy (mTB) system that integrates magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion technology. This study compares prostate cancer (PCa) detection rates between these two biopsy methods, assessing the clinical utility and diagnostic accuracy of our novel fusion technique. Our technology combines MRI and TRUS using the VENUS multimodal image fusion ultrasound system, which automatically merges imaging data, creates 3D prostate models, and performs automated analysis of suspicious lesions to guide precise biopsy planning. We retrospectively analyzed 301 patients who underwent prostate biopsies at Wujin People’s Hospital in Changzhou City from January 2023 to December 2024. All patients received 12 core systematic biopsies (SBx). When suspicious lesions were found, additional targeted biopsies (TBx) were performed. We compared clinically significant prostate cancer (csPCa) and any PCa detection rates, as well as the number of biopsy-positive cores, between the mTB group (n = 152) and the cTB group (n = 149). Compared to cTB, mTB significantly increased the detection rates of csPCa (48.7% vs. 32.2%, p = 0.004) and any PCa (53.3% vs. 40.9%, p = 0.032). The proportion of csPCa among all PCa cases was also higher with mTB (91.4% vs. 78.7%, p = 0.032). Patients undergoing combined TBx and SBx had a higher percentage of positive cores with mTB than with cTB (35.8% vs. 26.2%, p < 0.001), whereas no significant difference was observed in patients undergoing SBx alone. Multivariable logistic regression analysis demonstrated that mTB significantly improved PCa detection compared to cTB (p = 0.008). Furthermore, the overall rate of postoperative complications was significantly lower in the mTB group (p = 0.029). Our developed MRI-TRUS fusion technology markedly enhances detection of csPCa through precise intraoperative biopsy. Given its feasibility and accuracy, this technology holds strong potential for future clinical application.