Aims: This study aimed to evaluate the diagnostic value of real-time shear wave elastography (SWE) combined with magnetic resonance imaging-ultrasound (MRI-US) cognitive fusion targeted biopsy in repeat prostate biopsy. Methods: The retrospective cohort study comprised 120 patients who underwent transperineal repeat biopsy. Group A (n = 64) had standard cognitive fusion targeted biopsy plus systematic biopsy; Group B (n = 56) had additional real-time SWE before cognitive fusion to refine targeting. The primary endpoint of the study was the clinically significant prostate cancer (csPCa), which was based on targeted cores. Secondary endpoints encompassed the following: overall PCa detection, core-specific cancer detection rate, agreement with final pathology, diagnostic performance, and complications. Results: It is evident from the data that Group B had a significantly higher csPCa detection rate in comparison to Group A (p p p p p > 0.05). Conclusions: The combination of real-time SWE and MRI-US cognitive fusion targeted biopsy has been shown to be associated with a higher detection rate of clinically significant prostate cancer and improved biopsy accuracy during repeat biopsies, offering incremental diagnostic value without additional risks.
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