Re: Thomas Paul Scherer, Dominik Menges, Uwe Bieri, et al. Impact of Prebiopsy Multiparametric Magnetic Resonance Imaging on Prostate Cancer Detection in Switzerland. Eur Urol Open Sci 2025;73:1–7

We read with interest the study by Scherer et al [1] on the role of multiparametric magnetic resonance imaging (mpMRI)-guided prostate biopsy in the changing landscape for prostate cancer (PC) detection in Switzerland. While this article describes significant changes in the diagnosis of PC after the introduction of mpMRI, it suffers from several clinical and methodological limitations that warrant further discussion and investigation.

First, this study revealed a decrease in detection of low-risk PC and an increase in detection of intermediate-risk PC cases after implementation of fusion biopsies in routine clinical practice. However, the quality of mpMRI is a significant factor that influences oncological outcomes of fusion biopsies [2], and thus higher diagnostic rates for PC may be a result of within-institution variability in mpMRI performance. The quality and interpretation of mpMRI vary significantly across different MRI scanners (1.5 or 3 T), radiologists (experienced or not), and other factors that may the influence diagnostic accuracy and reproducibility of this imaging modality. In addition to variability in mpMRI performance, the fusion biopsy technique was not standard among the different institutions. The authors should take into account that biopsy results also depend on the number of biopsy cores taken and the biopsy strategy used (saturation or lesional/perilesional) [3]. These confounding factors were not taken into consideration by the authors and were not mentioned as limitations of the study.

In addition, although the authors recognized age as an important factor that affects PC detection by computing age-standardized PC incidence rates, other factors such as prostate-specific antigen (PSA), PSA density, and the number of cores play a significant role in PC diagnosis via both standard and fusion biopsies [3]. Therefore, the authors should present diagrams of PC incidence as a function of time-standardized data for factors such as number of cores, PSA, and PSA density to increase the accuracy and robustness of the study findings.

Regarding the methodology used, bias is inherent in ecological studies because of their descriptive design. This study searched for a possible association between PC incidence rates and the time period using aggregated data, but it failed to further investigate any etiological relationship between PC incidence and other factors. Finally, because of the descriptive nature of the study, it does not provide data on long-term clinical outcomes. Without longitudinal follow-up, it remains unclear if this change in diagnostic pattern is related to a significant survival advantage.

In conclusion, although the article describes a dramatic effect of the implementation of mpMRI fusion biopsies on PC diagnosis, the findings should be interpreted with caution because of the limitations of the study and the parameters that were not taken into consideration by the authors.



Conflicts of interest: The authors have nothing to disclose.