Transperineal Free-Hand Prostate Fusion Biopsy with AI-Driven Auto-Contouring: First Results of a Prospective Study

• Published in: Cancers Vol. 17; no. 14; p. 2381
• Main Authors: Oderda, Marco, Calleris, Giorgio, Dematteis, Alessandro, Greco, Alessandro, Marquis, Alessandro, Marra, Giancarlo, Merani, Umberto, Sasia, Alberto, Venturi, Alessio, Zitella, Andrea, Gontero, Paolo
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 18.07.2025; MDPI
• Subjects: Algorithms; Anesthesia; Artificial intelligence; Biopsy; Clinical significance; Health aspects; Image processing; Local anesthesia; Magnetic resonance imaging; Methods; Patients; Prostate; Prostate cancer; Software; Technology application; Ultrasonic imaging; Ultrasound; Urology; Italy; fusion; prostate biopsy; free-hand; auto-contouring; esaote; AI; transperineal
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers17142381

Background: prostate fusion biopsies are key in the diagnosis of prostate cancer (PCa); however, the fusion imaging system is not always user-friendly or reliable. The aim of this study was to assess the feasibility, accuracy, and effectiveness of transperineal fusion biopsies performed with a novel fusion imaging device equipped with AI-driven auto-contouring. Methods: data from 148 patients who underwent MRI-targeted and systematic prostate fusion biopsy with UroFusion (Esaote) were prospectively collected. All biopsies were performed in-office, under local anaesthesia. Results: cancer detection rate was 64% overall and 56% for clinically significant PCa (csPCa, ISUP ≥ 2). PCa was detected in 35%, 65% and 84% of lesions scored as PI-RADS 3, 4 and 5, respectively. Outfield positive systematic cores were found in the contralateral lobe in one third of cases. Median device-time to obtain fusion imaging was 5 min and median biopsy duration was 15 min. Median difference in volume estimation between ultrasound and MRI auto-contouring was only 1 cc. Detection rate did not differ between experienced and novice, supervised users. Conclusions: in this initial prospective experience, fusion biopsies performed with UroFusion AI-driven auto-contouring system appeared time-efficient, accurate, well tolerated, and user-friendly, with comparable outcomes between experienced and novice users. Systematic biopsies remain highly recommended given the non-negligible rates of positive outfield cores.