For a study, researchers sought to look into particular imaging and patient-related aspects of prostate fusion biopsies (TBx) of worrisome MRI lesions that resulted in a false negative (FN).

Men with PI-RADS 4 or 5 lesions were studied retrospectively. With TBx and systematic biopsy (SBx) procedures, November 2015–December 2020, only FN and true positive (TP) targeted lesions were present. A positive systematic core in the ROI or perilesional sextant and a negative TBx was considered an FN biopsy. The correlation between patient- and imaging-specific characteristics and the likelihood of an FN TBx were examined using logistic regression.

A total of 361 PI-RADS 4 or 5 lesions in 304 individuals, including 294 TP (81%) and 67 FN (19%), were included. Lesion size (OR: 0.94, P-value:.02), the existence of a suspicious DRE (OR: 0.36, P-value:.02), and PSA density (OR: 0.01, P-value:.004) all had a statistically significant negative correlation with the likelihood of getting an FN TBx. Age, biopsy indication, enema usage before MRI, prostate size, or the discrepant US and MRI segmentation volumes did not affect the likelihood of an FN TBx.

Over 19% of the csPCa missed by TBx in the cohort were found by SBx. Lower PSAD readings, smaller PI-RADS 4/5 lesions, and a normal DRE were all linked to a higher likelihood of an FN TBx.