A new study of 1,203 men who underwent MRI–ultrasound (MRI–US) fusion-guided prostate biopsy between 2014 and 2023 finds that larger prostate volume is strongly associated with lower prostate cancer detection rates, prompting calls to factor gland size into diagnostic planning. Overall cancer was detected in 62.0% of patients and clinically significant prostate cancer (csPCa) in 39.5%, but detection fell steadily as prostate size increased.
Patients with prostates under 30 mL had the highest overall detection rate at 82.3%; rates dropped to 67.1% for 30–54.9 mL, 50.2% for 55–79.9 mL, 48.5% for 80–119.9 mL and 28.9% for glands of 120 mL or more. A similar decline appeared for clinically significant disease, falling from 59.4% in the smallest group to 24.4% in the largest.
The effect persisted across PI-RADS categories: among men with PI-RADS 5 lesions, detection fell from 87.1% in prostates below 50 mL to 69.2% in prostates above 100 mL, with comparable reductions in PI-RADS 4 and 3 groups. Multivariable analysis in the study identified prostate volume as an independent predictor of biopsy detection after adjusting for other factors.
Authors note several mechanisms that may explain poorer performance in large glands, including reduced specificity of prostate-specific antigen (PSA) in benign enlargement, anatomical changes in the transition zone, and technical difficulty in accurately sampling target tissue-especially as larger prostates showed a higher proportion of anterior lesions and fewer positive digital rectal examinations.
The researchers conclude that prostate volume should be incorporated into clinical decision-making for MRI–US fusion biopsy and that larger glands may require adapted sampling strategies to avoid missed clinically significant cancers. (Franz T et al. Are big prostates a challenge? Correlation between prostate volume and detection rate in fusion biopsy of the prostate. Adv Urol. 2026; DOI: 10.1155/aiu/5999882.)
Original Source: https://www.emjreviews.com/urology/news/larger-prostates-reduce-cancer-detection-in-fusion-biopsy/
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Publish Date: 2026-06-27 17:33:00
