Abstract
Background: Prostate cancer is a growing national health issue in Iraq, and the traditional transrectal ultrasound (TRUS)-guided biopsy is usually not ideal in the detection of clinically significant prostate cancer (csPCA). The current study evaluates the diagnostic ability of magnetic resonance imaging-ultrasound (MRI-US) fusion biopsy among a prospective group of Iraqi men.
Methods: 135 men aged 65.4 years on average, with the median prostate-specific antigen (PSA) of 12.8ng/ml, were recruited in three tertiary hospitals in Baghdad between January 2024 and December 2025 with a prostate imaging reporting and data system (PI-RADS) of 3 or higher. Multiparametric MRI and TRUS fusion biopsy was performed on all subjects with the UroNav system, which fused between 4.2 targeted cores and 11.8 systematic cores per patient. Prostate cancer that was considered clinically significant was characterized as a Gleason score of 3 4 or 50 percent positive cores. The outcomes measured were detection rates, histopathologic distribution, procedural complications, and 6-month post-diagnostic management. The statistical tests were conducted using SPSS version 27 and chi-square tests and logistic regression; a statistical significance of p was defined as p <0.05.
Findings: The general rate of detecting prostate cancer was 57.8 (csPCa 38.5). Fusion biopsy was found to uniquely identify 42.317 percent of the cases of csPCa. PI-RADs stratification showed increasing yields of 15.8 per cent of score three lesions to 51.4 per cent of score five lesions. Most of the cases (53.8%) had localized disease. The incidents of procedural complications were mild, with hematuria being seen in 33.33 percent and sepsis in 1.5 percent. During the 6-month follow-up, 23.1 % of the patients went under active surveillance, with 15.4% percent undergoing focal therapy.
Conclusions: MRI9US hybrid biopsy has a significant enhancement in detecting clinically relevant prostate cancer in Iraq, thereby mitigating incidental low-grade prostate cancer and developing accurate treatment plans, especially in the case of late presentations. It is advisable that MRI hubs should be nationwide established and artificial intelligence improved to reduce the current disparities.