Transrectal ultrasound biopsy with magnetic resonance imaging fusion: a comparative analysis between cognitive and software-assisted fusion

Introduction: Prostate cancer is the most common malignancy of the male genitourinary system. Its diagnosis relies on prostate-specific antigen (PSA) testing, digital rectal examination (DRE), and increasingly, multiparametric magnetic resonance imaging (mpMRI). Histological confirmation is obtained through transrectal ultrasound (TRUS)-guided biopsy, either with cognitive MRI-TRUS fusion or software-assisted fusion. Objective: To compare the diagnostic performance of cognitive versus software-assisted MRI-TRUS fusion biopsy in detecting prostate cancer. Method: We conducted a retrospective study of patients with suspected prostate cancer and PI-RADS 3-5 lesions who underwent cognitive or software-assisted MRITRUS fusion biopsy between 2020 and 2022. Clinical, imaging, and pathological variables were analyzed, and the performance of both techniques was compared. Results: No significant differences were found in overall cancer detection between the two techniques (63.3% cognitive vs. 63.5% software). Subgroup analyses according to PI-RADS score, prostate volume, and abnormal DRE showed non-significant variations in detection rates. Conclusions: Cognitive and software-assisted MRI–TRUS fusion biopsies demonstrated comparable diagnostic performance. The choice between techniques should be guided by clinical context and resource availability, as both approaches offer accurate histopathological confirmation in patients with suspicious mpMRI findings.