Multiparametric Magnetic Resonance Imaging in the Diagnosis of Prostate Cancer. Prostate Fusion Biopsy. Clinically Insignificant Prostate Cancer
DOI:
https://doi.org/10.12775/JEHS.2026.95.73969Keywords
multiparametric magnetic resonance imaging, prostatic neoplasms, image-guided biopsy, clinically significant prostate cancer, active surveillanceAbstract
Background. Prostate cancer diagnosis must balance the early detection of clinically significant disease against the overdiagnosis of indolent tumors. Multiparametric magnetic resonance imaging (mpMRI) has transformed the diagnostic pathway by functioning as a triage test before biopsy and by enabling targeted sampling.
Aim. This narrative review evaluates the role of mpMRI, prostate fusion biopsy, and clinically insignificant prostate cancer in modern prostate cancer diagnostics and management.
Material and methods. A narrative review was prepared using peer-reviewed literature from PubMed and Google Scholar published between 2021 and 2026. Included sources comprised randomized and prospective studies, diagnostic cohorts, systematic reviews, meta-analyses, expert reviews, active surveillance studies, artificial intelligence studies, and health-economic analyses.
Results. Evidence consistently demonstrates that mpMRI improves the detection of clinically significant prostate cancer while reducing unnecessary biopsies and the overdiagnosis of clinically insignificant disease. MRI-targeted biopsy outperforms systematic biopsy for identifying clinically significant tumors, whereas the combined targeted and systematic approach provides the highest overall diagnostic accuracy. Nevertheless, clinically significant MRI-invisible cancers may still occur, highlighting the importance of integrating imaging findings with clinical risk factors. Emerging applications of artificial intelligence and optimized risk stratification may further enhance diagnostic performance.
Conclusions. mpMRI-centered diagnostic pathways reduce unnecessary biopsies and the overdiagnosis of indolent tumors while supporting individualized biopsy and surveillance decisions. Their effectiveness depends on imaging quality, clinical expertise, biopsy technique, patient risk profile, and cost considerations.
References
[1] Rybak J, Magiera B, Magiera K. Prostate cancer - risk factors and prevention strategies. Journal of Education, Health and Sport 2023;21:197–211. https://doi.org/10.12775/JEHS.2023.21.01.018.
[2] Olko P, Licak G, Tomkiewicz J, et al. The influence of genetic and environmental factors on the incidence of prostate cancer in men. Journal of Education, Health and Sport 2023;13:271–82. https://doi.org/10.12775/JEHS.2023.13.03.036.
[3] Janiszewska M, Imbirska B, Prager-Zimny M, et al. The role of plant-based diet in prostate cancer – a review of literature. Journal of Education, Health and Sport 2025;86:67417. https://doi.org/10.12775/JEHS.2025.86.67417.
[4] Chakrabarti D, Albertsen P, Adkins A, et al. The contemporary management of prostate cancer. CA Cancer J Clin 2025;75:552–86. https://doi.org/10.3322/caac.70020.
[5] Williams IS, McVey A, Perera S, et al. Modern paradigms for prostate cancer detection and management. Medical Journal of Australia 2022;217:424–33. https://doi.org/10.5694/mja2.51722.
[6] Hugosson J, Månsson M, Wallström J, et al. Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only. New England Journal of Medicine 2022;387:2126–37. https://doi.org/10.1056/NEJMoa2209454.
[7] Park JJ, Kim CK. Paradigm Shift in Prostate Cancer Diagnosis: Pre-Biopsy Prostate Magnetic Resonance Imaging and Targeted Biopsy. Korean J Radiol 2022;23:625. https://doi.org/10.3348/kjr.2022.0059.
[8] Stavrinides V, Norris JM, Karapanagiotis S, et al. Regional Histopathology and Prostate MRI Positivity: A Secondary Analysis of the PROMIS Trial. Radiology 2023;307:e220762. https://doi.org/10.1148/radiol.220762.
[9] Belue MJ, Yilmaz EC, Daryanani A, et al. Current Status of Biparametric MRI in Prostate Cancer Diagnosis: Literature Analysis 2022;12:804. https://doi.org/10.3390/life12060804.
[10] Lee CH, Vellayappan B, Tan CH. Comparison of diagnostic performance and inter-reader agreement between PI-RADS v2.1 and PI-RADS v2: systematic review and meta-analysis. Br J Radiol 2022;95. https://doi.org/10.1259/bjr.20210509.
[11] Tan N, Pollock JR, Margolis DJA, et al. Management of Patients With a Negative Multiparametric Prostate MRI Examination: AJR Expert Panel Narrative Review. American Journal of Roentgenology 2024;223. https://doi.org/10.2214/AJR.23.29969.
[12] Zattoni F MASMMMLNZG. Diagnosis of clinically significant prostate cancer after negative multiparametric magnetic resonance imaging. Cent European J Urol 2022. https://doi.org/10.5173/ceju.2022.0092.
[13] Triquell M, Campistol M, Celma A, et al. Magnetic Resonance Imaging-Based Predictive Models for Clinically Significant Prostate Cancer: A Systematic Review. Cancers (Basel) 2022;14:4747. https://doi.org/10.3390/cancers14194747.
[14] Ma Z, Wang X, Zhang W, et al. Developing a predictive model for clinically significant prostate cancer by combining age, PSA density, and mpMRI. World J Surg Oncol 2023;21:83. https://doi.org/10.1186/s12957-023-02959-1.
[15] Xie J, Jin C, Liu M, et al. MRI/Transrectal Ultrasound Fusion-Guided Targeted Biopsy and Transrectal Ultrasound-Guided Systematic Biopsy for Diagnosis of Prostate Cancer: A Systematic Review and Meta-analysis. Front Oncol 2022;12. https://doi.org/10.3389/fonc.2022.880336.
[16] Rebez G, Barbiero M, Simonato FA, et al. Targeted Prostate Biopsy: How, When, and Why? A Systematic Review. Diagnostics 2024;14:1864. https://doi.org/10.3390/diagnostics14171864.
[17] Falagario UG, Pellegrino F, Fanelli A, et al. Prostate cancer detection and complications of MRI-targeted prostate biopsy using cognitive registration, software-assisted image fusion or in-bore guidance: a systematic review and meta-analysis of comparative studies. Prostate Cancer Prostatic Dis 2025;28:270–9. https://doi.org/10.1038/s41391-024-00827-x.
[18] Pirola GM, Castellani D, Orecchia L, et al. Transperineal US-MRI Fusion-Guided Biopsy for the Detection of Clinical Significant Prostate Cancer: A Systematic Review and Meta-Analysis Comparing Cognitive and Software-Assisted Technique. Cancers (Basel) 2023;15:3443. https://doi.org/10.3390/cancers15133443.
[19] Zattoni F, Rajwa P, Miszczyk M, et al. Transperineal Versus Transrectal Magnetic Resonance Imaging–targeted Prostate Biopsy: A Systematic Review and Meta-analysis of Prospective Studies. Eur Urol Oncol 2024;7:1303–12. https://doi.org/10.1016/j.euo.2024.07.009.
[20] in de Braekt T, van Rooij SBT, Daniels-Gooszen AW, et al. Accuracy of MRI-ultrasound fusion-guided and systematic biopsy of the prostate. British Journal of Radiology 2024;97:1132–8. https://doi.org/10.1093/bjr/tqae080.
[21] Pham THN, Schulze‐Hagen MF, Rahnama’i MS. Targeted multiparametric magnetic resonance imaging/transrectal ultrasound‐guided ( mpMRI / TRUS ) fusion prostate biopsy versus systematic random prostate biopsy: A comparative real‐life study. Cancer Rep 2024;7. https://doi.org/10.1002/cnr2.1962.
[22] Parsons M, Sandhu Z, Foy B, et al. Concordance of MRI-Guided Fusion and Systematic 12-Core Prostate Biopsy for the Detection of Prostate Cancer. Front Oncol 2022;12. https://doi.org/10.3389/fonc.2022.899567.
[23] Oderda M, Dematteis A, Calleris G, et al. MRI-Targeted Prostate Fusion Biopsy: What Are We Missing outside the Target? Implications for Treatment Planning. Current Oncology 2024;31:4133–40. https://doi.org/10.3390/curroncol31070308.
[24] Jahnen M, Amiel T, Wagner T, et al. Does experience change the role of systematic biopsy during MRI-fusion biopsy of the prostate? World J Urol 2023;41:2699–705. https://doi.org/10.1007/s00345-023-04564-z.
[25] Beetz NL, Dräger F, Hamm CA, et al. MRI-targeted biopsy cores from prostate index lesions: assessment and prediction of the number needed. Prostate Cancer Prostatic Dis 2023;26:543–51. https://doi.org/10.1038/s41391-022-00599-2.
[26] Sanmugalingam N, Sushentsev N, Lee K-L, et al. The PRECISE Recommendations for Prostate MRI in Patients on Active Surveillance for Prostate Cancer: A Critical Review. American Journal of Roentgenology 2023;221:649–60. https://doi.org/10.2214/AJR.23.29518.
[27] Rajwa P, Pradere B, Quhal F, et al. Reliability of Serial Prostate Magnetic Resonance Imaging to Detect Prostate Cancer Progression During Active Surveillance: A Systematic Review and Meta-analysis. Eur Urol 2021;80:549–63. https://doi.org/10.1016/j.eururo.2021.05.001.
[28] Ellis EE, Frye TP. Role of multi-parametric magnetic resonance imaging fusion biopsy in active surveillance of prostate cancer: a systematic review. Ther Adv Urol 2022;14. https://doi.org/10.1177/17562872221106883.
[29] Wallaengen V, Zacharaki EI, Alhusseini M, et al. mpMRI-Based Risk Estimation to Optimize Prostate Cancer Patient Selection for Active Surveillance. Cancers (Basel) 2026;18:842. https://doi.org/10.3390/cancers18050842.
[30] Antolin A, Roson N, Mast R, et al. The Role of Radiomics in the Prediction of Clinically Significant Prostate Cancer in the PI-RADS v2 and v2.1 Era: A Systematic Review. Cancers (Basel) 2024;16:2951. https://doi.org/10.3390/cancers16172951.
[31] Cai JC, Nakai H, Kuanar S, et al. Fully Automated Deep Learning Model to Detect Clinically Significant Prostate Cancer at MRI. Radiology 2024;312. https://doi.org/10.1148/radiol.232635.
[32] Rezapour A, Alipour V, Moradi N, et al. Cost-Effectiveness of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy Versus Systematic Transrectal Ultrasound-Guided Biopsy for Prostate Cancer Diagnosis: A Systematic Review. Value Health Reg Issues 2022;30:31–8. https://doi.org/10.1016/j.vhri.2021.10.007.
[33] Bąk S, Budzeń K, Wesołowski P, et al. Review of diagnostic methods for prostate cancer with consideration of MRI-TRUS fusion biopsy. Journal of Education, Health and Sport 2022;12:720–8. https://doi.org/10.12775/JEHS.2022.12.09.085.
[34] Hao S, Karlsson A, Heintz E, et al. Cost-Effectiveness of Magnetic Resonance Imaging in Prostate Cancer Screening: A Microsimulation Study. Value in Health 2021;24:1763–72. https://doi.org/10.1016/j.jval.2021.06.001.
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