Is MRI/US-guided fusion biopsy ready to replace systematic biopsy in detecting clinically significant prostate carcinoma? – A retrospective study

Purpose: This study aims to evaluate whether MRI-US-guided FB leads to improved diagnostic accuracy compared to SB in detecting csPCa, further assessing whether the TP or TR biopsy approach influences outcomes. Methods: A retrospective, single-center analysis was performed on 851 (Median age 70) patients who underwent combined FB and SB when PIRADS 3 or higher was indicated on mpMRI between June 2019 and November 2024. The highest ISUP-GG was compared between the two biopsy methods with analysis of discordant findings between the methods. Furthermore, the detection rates of csPCa were compared between the TP and TR access routes. Results: FB identified higher ISUP GG in 70.97% of discordant cases, with FB detecting csPCa in 42.2%of patients compared to 28.5% by SB ( p  < 0.001). Insignificant PCa was detected with similar frequency by both methods, with a close majority for the SB (30.3%) vs. FB (28.2%). Statistically significant association in csPCa detection rates was found between TP (50.1%) and TR (43.0%) approaches ( p  = 0.038). Conclusion: FB significantly improves the detection of higher ISUP GG and csPCa compared to SB. However, the use of both methods together provides the most reliable diagnosis.