An important new study (July 2025) examines how well the results of in-bore MRI guided targeted prostate biopsy match actual prostate specimens removed during prostatectomy. The key word, concordance, may not be familiar to prostate cancer (PCa) patients. If you look at the root word, concord, it means agreement or harmony. As an example, imagine an ideal world where all people live in peace and concord. Sounds like a dream come true, right?

In medicine, concordance also means agreement. The title of the study has the word itself in it: “Histopathologic Yields and Concordance of In-Bore MRI-targeted Biopsy for Prostate Cancer Diagnosis.”^[i] However, histopathologic yields may require additional translation.

• Histopathologic means the study of abnormal tissue under a microscope. Obtaining that tissue may be done by taking samples (e.g., surface skin scraping by a dermatologist, image-guided needle biopsy of internal organs, surgically removed tissues) to be examined in a lab by a specialist trained in such analysis.
• Yields means the results of such analysis.

Thus, histopathologic yield means the results of diagnosing body tissues under a microscope.

A comparison study

For this study, 780 patients had multiparametric MRI (either 1.5T magnet or 3T magnet) scored using PI-RADS. All than had in-bore (in the magnet) MRI-guided targeted biopsy into suspicious lesions seen on MRI. 489 biopsies were positive for PCa and given a Grade Group (GG, from 1 to 5). Of these, 216 went on to have radical prostatectomy, so those specimens were then submitted for histopathologic examination and given another GG.

These 216 surgical grade group (sGG) specimens were then compared with the biopsy grade group (bGG) samples to look for concordance between the two for each patient. Would the targeted biopsy results detect clinically significant PCa (GG 2 or higher), and would they agree with the surgical results? If so, could correlating factors be identified?

The authors found the greatest targeted biopsy rates of detecting significant PCa when PI-RADS scores were 4-5, and lesions were 10 mm or larger. As for concordance, the researchers report “moderate to substantial” agreement, reporting a range of rates: “There was lower concordance for bGG 1 (33.9%) than for bGG 2 and 3 (76.2% and 72.9%, respectively).”^[ii] In fact, over half of the 62 GG1 patients who had prostatectomy were upgraded to GG2. The authors suggest that when a biopsy reveals GG1, there’s a risk of undertreating these patients who may in fact have higher grade cancer, so other factors such as PSA, appearance of MRI, etc. be taken into account before a treatment decision is made.

The authors also report that their biopsy detection rates were lower than those found in a 2022 study (Sandahl et al.^[iii]) of 884 patients in which the research team

observed higher detection rates than we did for both prostate cancer (72% for manual and 73% for robotic systems) and clinically significant prostate cancer (51% for manual and 42% for robotic systems). The differences in prostate cancer detection rates may be due to the diameter of the biopsied lesions: a median of 15 mm and 14 mm for manual and robotic systems in the study by Sandahl et al versus a median of 10 mm and 8 mm, respectively, in our study. Patient selection and the smaller diameter of lesions in our study likely contributed to the overall lower detection rates of prostate cancer and clinically significant prostate cancer compared with the general literature.^[iv]

This and similar studies are important ways to ensure that mpMRI is performing as intended, before biopsy, as well as before, during and after MRI-guided focal treatments. Accuracy is always the top priority. We are proud that our Center offers excellence in MRI-based detection, diagnosis and image-guided treatments thanks to

• 15 years of authoritative experience in developing and applying mpMRI to prostate cancer
• State of the art 3T magnet with specialized software and AI integration
• Knowledgeable and seasoned clinical team
• Commitment to patient education and compassionate care.

We have a high degree of confidence in the precision of our detection and diagnostic in-bore biopsy. For more information, please contact us.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Sattin C, Pizzi C, Summers P, Gaeta A et al. Histopathologic Yields and Concordance of In-Bore MRI-targeted Biopsy for Prostate Cancer Diagnosis. Radiology. 2025 Jul;316(1):e241710.
[ii] Ibid.
[iii] Sandahl M, Sandahl KJ, Marinovskij E, et al. Prostate cancer detection rate of manually operated and robot-assisted in-bore magnetic resonance imaging targeted biopsy. Eur Urol Open Sci 2022;41:88–94.
[iv] Sattin, ibid.