Meeting Cancer Detection Benchmarks in MRI/Ultrasound Fusion Biopsy for Prostate Cancer: Insights from a Retrospective Analysis of Experienced Urologists
by
, ,
Fabian Utzat
1,†, 
Stefanie Herrmann
2,*,†,
Matthias May
2, 
Johannes Moersler
3,
Ingmar Wolff
4
,
Johann Lermer
2,
Mate Gregor
5,
Katharina Fodor
2,
Verena Groß
2,
Anton Kravchuk
2,
Thomas Elgeti
6,
Stephan Degener
1,‡ and
Christian Gilfrich
2,‡ 1
Department of Urology, University of Witten/Herdecke, 42283 Wuppertal, Germany
2
Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
3
Department of Radiology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
4
Department of Urology, University Medicine Greifswald, 17475 Greifswald, Germany
5
Institute of Pathology, Hospital Deggendorf, 94469 Deggendorf, Germany
6
Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
‡
These authors also contributed equally to this work.
Cancers 2025, 17(2), 277; https://doi.org/10.3390/cancers17020277
Submission received: 5 November 2024
/
Revised: 18 November 2024
/
Accepted: 14 January 2025
/
Published: 16 January 2025
(This article belongs to the Special Issue Prostate Cancer Therapy: Supporting Strategies and Management Options)
Simple Summary
This study examines how quickly experienced urologists learn to perform a specialized prostate biopsy method that combines MRI and ultrasound to detect prostate cancer. This technique, called ultrasound/MRI fusion biopsy (UMFB), enhances the detection of aggressive cancers while helping to avoid unnecessary treatment for less harmful cases. We observed two urologists, each with over 15 years of experience, and found that both doctors met high standards for cancer detection from the outset, showing no need for an extended learning period. This study also shows that combining two biopsy methods—targeted and systematic—was more effective in identifying significant cancers. Regular patient follow-ups further verified the accuracy of the biopsy results. Overall, this study highlights that with proper training and teamwork, UMFB can be safely and effectively implemented from the beginning, improving diagnostic outcomes for prostate cancer patients.
Abstract
Background: The relationship between case volume and clinical outcomes is well established for most urological procedures but remains underexplored in prostate ultrasound/MRI fusion biopsy (UMFB). UMFB aims to detect clinically significant prostate cancer (csPCa) by adhering to cancer detection benchmarks for PI-RADS lesions identified via multiparametric MRI (mpMRI). These benchmarks, defined by Ahmed et al., include cumulative cancer detection rate (C-CDR) targets of >80% for PI-RADS 5, >50% for PI-RADS 4, and <20% for PI-RADS 1–3. Methods: This retrospective, single-center study analyzed the case volumes required for two experienced urologists (U1 and U2, each with >15 years of practice) to consistently achieve the Ahmed-defined C-CDR benchmarks for csPCa (ISUP grade ≥ 2) using UMFB. Both transrectal and transperineal approaches were included to enable comprehensive learning curve analysis. Data from 2017 to 2023 were reviewed, encompassing 157 UMFBs performed by U1 and 242 by U2, with a transrectal-to-perineal ratio of 7:3. Results: Both urologists achieved Ahmed-defined C-CDR targets from the outset. Over a median follow-up of 30 months, patients with initial PI-RADS 4 or 5 ratings and negative primary biopsies remained prostate cancer-free in 77% of cases for U1 and 91.2% for U2 (p = 0.152). Conclusions: This study demonstrates that experienced urologists can achieve high diagnostic accuracy and maintain patient safety immediately upon implementing UMFB, meeting established benchmarks without requiring additional procedural learning.
