Volume 14, Supplement 1
Original Article / Published: April 2026
DOI: https://www.doi.org/10.57045/jemis/1410426.pp16-17
V. Todorova, O. Gatsev, K. Hristov, K. Petkova, I. Saltirov
Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
Abstract
Introduction: Introduction of multiparametric magnetic resonance imaging (mpMRI) into diagnostic algorithm for prostate cancer has significantly improved the ability to localize lesions and assess the risk of clinically significant disease. However, establishing a definitive diagnosis requires precise histological verification. Lesions located in prostatic apex present a diag-nostic challenge due to their anatomical proximity to the external sphincter and the limited ability to obtain accurate biopsy samples using conventional techniques. The integration of MRI/ultrasound fusion technology with a transperineal biopsy approach provides higher targeting precision and improved access to the region of interest.
Objective: The aim of the study is to evaluate the diagnostic performance of MRI/ultrasound guided fusion biopsy with transperineal approach in detection of prostate cancer localized in the prostatic apex.
Matherials and methods: A retrospective analysis of patient data was conducted for the period from January 2022 to August 2025. All patients included in the study had MRI findings suspicious for prostate cancer, with lesions located in the prostatic apex. The respective lesions were assessed according to the PI-RADS classification, with a score of 3 or higher. MRI/ultrasound guided fusion biopsy was performed using a transperineal approach. The obtained histopathological results were subjected to statistical analysis.
Results: The study included 40 patients. The mean age of the cohort was 69.9 ± 8.8 years. Total PSA levels were 13.1 ± 15.5 ng/ml, and the mean prostate volume was 48.6 ± 23.5 cc. MRI findings demonstrated PI-RADS 3 lesions in 32.5% of cases, PI-RADS 4 in 50%, and PI-RADS 5 in 17.5%. Following biopsy, 30% of patients were diagnosed with benign prostatic hyperplasia, while 5% were diagnosed with high-grade prostatic intraepithelial neoplasia (HGPIN). Low- grade prostate cancer was identified in 42.5% of cases, and high-grade prostate cancer in 22.5%. All carcinoma-positive cases were further stratified according to Gleason score. 32.4% of malignant histopathological results were classified as Gleason score 6 (3+3), 45.9% as Gleason score 7 (18.9% Gleason 3+4 and 27% Gleason 4+3), 13.5% as Gleason score 8, and 8.2% as Gleason score 9.
Conclusion: MRI/ultrasound guided fusion biopsy with transperineal approach demonstrates high diagnostic efficacy in the histological confirmation of clinically significant prostate cancer localized in the prostatic apex. The results obtained in this study establish the method as a valuable diagnostic tool for anatomically challenging lesions, such as those located in the prostatic apex.
Keywords:
magnetic resonance imaging, ultrasound, fusion biopsy, prostate cancer, apex
How to cite this article:
V. Todorova, O. Gatsev, K. Hristov, K. Petkova, I. Saltirov. Detection of Apical Prostate Cancer: The Value of MRI/US Fusion Transperineal Biopsy. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2026; 14(1): 16-17
Corresponding author:
Dr. Viktoria Todorova
Clinic of Urology
Department of Urology and Nephrology
Military Medical Academy
Sofia 1606,
Georgi Sofiyski Blvd. 3
Email: v.todorova0803@gmail.com