Volume 30, Issue 170, April 2026

MRI-TRUS Biopsy or Systematic TRUS Biopsy in the Diagnosis of Prostate Cancer: A State-of-the-Art Review

Piotr Banaszek^♦, Adam Szmidt, Mateusz Mazurek

Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland

^♦Corresponding author
Piotr Banaszek, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland

ABSTRACT

Objective: This study aims to analyze the diagnostic accuracy of TBx/FBx compared to SBx in detecting clinically significant prostate cancer (ISUP ≥ 2) and the safety profile of the TBx/FBx procedure in comparison with that of SBx based on a TP or TR approach. Methodology: This study includes articles obtained from a systematic search of the PubMed, Embase, Scopus, and Cochrane databases, published from 2013 through July 2025. The review included prospective comparative studies in men with suspected prostate cancer that evaluated MRI-targeted biopsy, against systematic TRUS biopsy and/or compared TP with TR access. Because the included studies varied in mpMRI protocols and outcome definitions, we summarised the findings narratively. Results: Fourteen studies (n=9,507) met the inclusion criteria. Seven (n = 6,249) directly compared TBx and SBx; overall detection rates were similar. However, TBX showed a more consistent ability to identify csPCa (9.29– 81% vs 8.8–82%). Combined TBX+SBx achieved the highest csPCa detection rates (34.7%-68%). Safety outcomes favored the TP route. In the PREVENT trial, the postbiopsy infection rate was 0% with TP (without prophylaxis), vs 1.6% with TR (with targeted prophylaxis). Conclusions: TBx tends to pick up more cases of csPCa than SBx. A combined approach increases the likelihood of detecting significant disease and reduces the risk of missing tumours not visible on mpMRI. TP and TR show comparable detection rates. Still, TP helps reduce infections. There is a clear need for common rules for defining outcomes and for larger randomized studies comparing targeted-only approaches with combined ones.

Keywords: prostate cancer (PCa); multiparametric magnetic resonance imaging (mpMRI); prostate biopsy; Fusion biopsy; Systematic biopsy; Review

Medical Science, 2026, 30, e79ms3867

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DOI: https://doi.org/10.54905/disssi.v30i170.e79ms3867

Published: 30 April 2026