Prostate cancer is one of the most common cancers in men. When diagnosed at an early stage, the chances of successful treatment are extremely high. However, conventional biopsy methods do not always guarantee that samples are taken from the correct site. For this reason, MR fusion biopsy and its most advanced form—artificial intelligence-assisted transperineal biopsy—have come to the forefront in recent years.

In this article, we explain how AI-assisted transperineal MR fusion prostate biopsy is performed, its advantages and disadvantages, and for whom it is suitable, based on Prof. Dr. Volkan İzol’s clinical approach.

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MR fusion biopsy is based on the principle of combining (fusing) magnetic resonance (MR) images of the prostate with real-time ultrasound (US) images. This allows suspicious areas to be clearly visualized on the MR images, and the biopsy needle can be precisely guided to these regions.

While in conventional biopsies needles are inserted into random areas, the MR fusion method enables “targeted” biopsies.

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The needle insertion site for the biopsy is important in terms of the procedure’s success and the risk of complications.

•The risk of infection is high with transrectal (performed through the rectum) biopsies.

•In transperineal biopsies (performed through the perineum, that is, between the anus and the scrotum), this risk drops to nearly zero.

For this reason, the transperineal approach is preferred, particularly in patients at high risk of infection, those with antibiotic resistance, or those in whom previous biopsies were inconclusive.

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Today, artificial intelligence algorithms have begun to play a major role in the interpretation of MRI images.

Artificial intelligence systems in MRI images:

•Automatically highlights suspicious areas,

•Supports PI-RADS scoring,

•Defines target regions for the fusion system,

•It reduces the margin of error for the physician and shortens the biopsy procedure.

Thanks to this technology, experienced surgeons such as Prof. Dr. Volkan İzol can evaluate MRI and ultrasound images simultaneously and perform biopsies with millimeter-level precision.

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1. Patient preparation: The procedure is usually performed under light sedation; bowel preparation is not required.

2. The MRI images are uploaded to the system.

3. AI-powered software highlights lesions detected on MRI scans.

4. The ultrasound probe is inserted through the perineal region and the ultrasound image is overlaid on the MRI image.

5. A sample is taken from the target site using a biopsy needle.

6. The process takes an average of 15–20 minutes.

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✅ The risk of infection is extremely low.

Since the transperineal approach does not come into contact with the rectal flora, the need for antibiotics is minimal.

✅ Sampling is conducted in a targeted and accurate manner.

With the help of artificial intelligence, samples can be taken from the exact center of lesions.

✅ The detection rate for significant cancers is higher.

In particular, tumors with a Gleason score of ≥7 are detected more accurately.

✅ It offers a second chance for patients with suspicious MRI lesions despite previous negative biopsy results.

✅ It allows for mapping the entire prostate (template mapping).

✅ It can be performed under local anesthesia or with light sedation and is comfortable.

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⚠️ Requires advanced technical hardware.

MRI fusion systems with AI integration are expensive and are not available at every center.

⚠️ The learning curve is steep.

Experience is essential for proper fusion and needle guidance.

⚠️ Initially, the cost is higher than that of a conventional biopsy.

However, because it reduces the need for repeat biopsies, it becomes more cost-effective in the long run.

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•Patients with elevated PSA levels and a negative conventional biopsy result

•Patients with suspicious PI-RADS 3–5 lesions on MRI

•Patients at risk of infection or with an allergy to antibiotics

•Those who have previously had an infection following a biopsy

•Patients seeking a targeted, safe, and painless biopsy

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Artificial intelligence-assisted transperineal MRI-guided prostate biopsy is one of the safest, most accurate, and most advanced methods for diagnosing prostate cancer.

This method reduces false-negative rates while preventing unnecessary repeat biopsies.

This technology, implemented under the leadership of Prof. Dr. Volkan İzol, combines minimally invasive approaches with expertise in robotic surgery to ensure that patients receive diagnoses with the highest degree of accuracy.

Early diagnosis saves lives when it comes to men's health.

If your PSA level is high, your MRI shows a suspicious area, or you still have concerns even though your previous biopsy came back negative, an AI-assisted transperineal MRI fusion biopsy may be the best option for you.