{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T07:09:47Z","timestamp":1789456187947,"version":"build-2803163510"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"The First Affiliated Hospital of Soochow University Clinical Diagnosis and Treatment Technology Innovation Project","award":["CXZL-A-240702"],"award-info":[{"award-number":["CXZL-A-240702"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Nucl Med Mol Imaging"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Multiparametric MRI (mpMRI)-ultrasound (US) fusion biopsy misses 8%-20% of clinically significant prostate cancer (csPCa), leaving a detection gap that prostate-specific membrane antigen (PSMA) PET\/CT may help close. Whether incorporating PSMA into an MRI-US fusion platform improves csPCa detection has not been evaluated in a prospective paired design. We compared tri-modal PSMA PET\/CT-MRI-US fusion biopsy with MRI-US fusion biopsy and systematic biopsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective, single-center, and paired diagnostic accuracy study (STARD 2015; ChiCTR2400089436), 308 biopsy-naive men underwent tri-modal fusion biopsy, MRI-US fusion biopsy, and systematic biopsy in a single session. The primary endpoint was the absolute difference in patient-level csPCa detection (International Society of Urological Pathology grade group\u2009\u2265\u20092) between tri-modal and MRI-US fusion biopsies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Tri-modal fusion detected 4.9% more csPCa than MRI-US fusion biopsy (95% confidence interval 2.4%-7.3%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001; number needed to biopsy 20.5). The most significant gains were observed for PSMA-positive lesions\u2009&lt;\u200910\u00a0mm (8.3%) and Prostate Imaging Reporting and Data System (PI-RADS) 4 lesions (5.8%), and this benefit persisted in multivariate generalized estimating equation models. The PSMA imaging-based risk score (area under the curve, 0.933) showed higher discrimination than the PRIMARY and molecular imaging PSMA scores. In a retrospective simulation using the test set, a risk-guided approach would have avoided approximately 42% of biopsies while missing 2.3% of csPCa. Limitations include the single-center design and the small test set.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tri-modal fusion was superior to MRI-US fusion biopsy in detecting csPCa, particularly in small PSMA-positive and PI-RADS 4 lesions. A PSMA-derived risk score enabled effective stratification, and in the test set, a simulated risk-guided approach showed potential for biopsy reduction. These findings require multicenter validation before clinical adoption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      ChiCTR2400089436 (Chinese Clinical Trial Registry,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.chictr.org.cn\/\" ext-link-type=\"uri\">http:\/\/www.chictr.org.cn\/<\/jats:ext-link>\n                      , registered 2024-09-09).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-026-08181-x","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:27:24Z","timestamp":1789453644000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tri-modal PSMA PET\/CT-MRI-US fusion biopsy for clinically significant prostate cancer: a prospective paired diagnostic study"],"prefix":"10.1007","author":[{"given":"Chen","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lichen","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yizhang","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menglin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuefeng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofeng","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuefeng","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ximing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingchuan","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renpeng","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihui","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengming","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxin","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuedong","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4161-1866","authenticated-orcid":false,"given":"Yuhua","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"issue":"3","key":"8181_CR1","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1016\/j.eururo.2020.05.042","volume":"78","author":"NJ Sathianathen","year":"2020","unstructured":"Sathianathen NJ, Omer A, Harriss E, et al. 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The study was performed in line with the principles of the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethics Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","label":"Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This manuscript does not contain any individual person\u2019s data in any form (including individual details, images or videos).","order":3,"name":"Ethics","label":"Consent to Publish","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing Interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"During the preparation of this manuscript, the authors used AI-assisted tool (DeepSeek) for language polishing and grammar checking. The authors reviewed and edited all AI-generated suggestions and take full responsibility for the content of this manuscript.","order":5,"name":"Ethics","label":"Artificial Intelligence Statement","group":{"name":"EthicsHeading","label":"Declarations"}}]}}