Jiangchuan Chen, Qiao Xu, Changlong Li, Jiamo Zhang
This study evaluates the clinical efficacy of transperineal 3D image registration combined with AI-electromagnetic navigation-guided mpMRI-TRUS fusion biopsy versus transrectal cognitive fusion biopsy for prostate cancer diagnosis. This retrospective cohort study analyzed 283 patients undergoing prostate biopsy at Yongchuan Hospital of Chongqing Medical University (January 2022 to December 2024). Participants were stratified into transrectal cognitive fusion (n = 146) and transperineal AI-navigated fusion (n = 137) groups. Detection rates of clinically significant prostate cancer (csPCa) and complication profiles were compared. Multivariable logistic regression identified independent predictors of csPCa detection. The transperineal AI-navigated fusion group demonstrated a significantly higher csPCa detection rate compared to the transrectal cognitive fusion group (55.5% vs 45.2%, P = .043). Multivariable logistic regression revealed that advanced age (OR = 1.05, 95% CI: 1.01-1.17), PI-RADS score > 3 (OR = 9.4, 95% CI: 3.95-16.74), and transperineal approach (OR = 3.65, 95% CI: 1.22-4.75) independently predicted csPCa detection. The AI-navigated group showed no hematochezia (0% vs 9.6%, P = .003), no sepsis (0% vs 2.1%, P = .246), and a significantly lower urinary tract infection rate (13.9% vs 28.8%, P = .035). However, urinary retention was significantly more frequent in the transperineal group (14.4% vs 7.3%, P = .012), although all cases resolved within 72 hours with conservative management. Transient perineal pain was also more frequent in the transperineal group (24.1% vs 8.9%, P = .017). AI-navigated transperineal fusion biopsy was associated with improved csPCa detection and a lower infectious complication rate compared to transrectal cognitive fusion biopsy, but with a significantly higher incidence of transient, self-limiting urinary retention. These findings support its potential as an effective diagnostic strategy, with the caveat that patients should be counseled regarding post-biopsy voiding function.