PROSTATE cancer (PCa) is among the most common malignancies in men. Accurate diagnosis relies heavily on prostate biopsies, which guide treatment decisions. Recent advancements in prostate imaging, particularly multiparametric magnetic resonance imaging (mpMRI), have transformed diagnostic approaches. Pre-biopsy mpMRI is now considered essential, enabling targeted biopsy (TB) methods such as cognitive fusion (cTB), in-bore MRI TB, and MRI-TRUS fusion TB. Each method has merits, but operator expertise and resource availability influence outcomes and adoption.
Artificial intelligence (AI) is revolutionising PCa diagnostics by enhancing imaging accuracy and reducing interoperator variability. AI models trained on MRI data can detect and localise clinically significant PCa (csPCa) with superior precision compared to human observers. A recent randomised controlled trial (RCT) at our institution demonstrated the potential of AI-cTB to significantly improve csPCa detection rates. This AI-driven method integrates seamlessly into clinical workflows, reducing overtreatment and optimising biopsy procedures.
Despite its promise, integrating AI into routine practice remains challenging. Limitations include the need for large, multicentre training datasets and further validation through prospective studies. Additionally, AI applications must address biases and ensure equitable performance across diverse populations.
The RCT findings highlight AI’s ability to enhance csPCa detection, particularly in complex cases, such as tumours in the transition zone or lesions undetectable via traditional TRUS. AI also improves efficiency, cutting reporting times while maintaining diagnostic confidence. Compared with conventional cTB, AI-cTB shows superior interoperator consistency, a more favourable learning curve, and reduced healthcare costs.
Future studies should focus on expanding AI applications to include emerging technologies like PSMA PET CT and transperineal biopsy approaches, which offer reduced infection risks. Multidisciplinary collaboration is essential to fully realise AI’s potential in precision medicine, paving the way for more accurate diagnoses and tailored PCa treatment strategies.
By optimising biopsy procedures and integrating advanced AI tools, the field is taking critical steps toward improving outcomes for PCa patients worldwide.
Katie Wright, EMJ
Reference
Deng R et al. Comparison of MRI artificial intelligence-guided cognitive fusion-targeted biopsy versus routine cognitive fusion-targeted prostate biopsy in prostate cancer diagnosis: a randomized controlled trial. BMC Med. 2024;22(1):530.
