Coaxial needle technique with real-time virtual magnetic navigation in transperineal MRI-TRUS fusion prostate biopsy: a multicenter retrospective study

Transperineal mpMRI–TRUS fusion biopsy is accurate but requires multiple perineal punctures, increasing pain and complications. The coaxial needle technique reduces these burdens in systematic biopsy, but its use in fusion targeted biopsy is unreported. This study assesses the benefits of employing a coaxial needle technique with real-time virtual magnetic navigation in transperineal mpMRI-TRUS cognitive fusion prostate biopsy. This multicenter retrospective study enrolled patients with elevated PSA or PI-RADS ≥ 3 lesions (December 2022–May 2026); exclusions included acute infection, severe coagulopathy, and heart failure. All groups underwent 14 cores (12 systematic + 2 targeted): A ( n = 51) cognitive fusion with coaxial needle and magnetic navigation; B ( n = 84) machine fusion without coaxial needle; C ( n = 181) free-hand TRUS-guided SB + TB without navigation. Continuous variables were analyzed by ANOVA/Kruskal–Wallis and categorical by chi-square/Fisher’s tests ( P < 0.05 significant). Positive core rates were higher in A (43.56%) and B (45.07%) than C (24.31%; both P < 0.05), with no difference between A and B. Procedure time was shorter in A (12.75 ± 3.58 min) than B (20.19 ± 2.63) and C (16.38 ± 2.76; both P < 0.05). VAS during sampling was lower in A (3.00 ± 1.34) than B (5.93 ± 2.48) and C (5.42 ± 2.80; both P < 0.05). Urinary retention (9.80%) and hematuria (13.73%) were numerically lower in A than B (21.43%, 23.81%) and C (20.44%, 22.65%). No significant differences were found among the groups in complication rates. In a non-randomized retrospective comparison, the coaxial needle technique with real-time virtual magnetic navigation was associated with reduced pain and procedure time, with numerically lower complication rates, without compromising cancer detection.