| Summary: | To date, although some benefits resulting from a software-guided technique are undeniable, no clear superiority of fusion over cognitive targeted biopsy (COG-TB) has been supported by strong evidence. We discuss potential causes of trials failing to show the superiority of fusion TB (FUS-TB) and highlight its advantages over the cognitive approach.One possible reason why current literature showed contradictory evidence in supporting FUS-TB may be the lack of high-quality well-designed trials. Indeed, most of the studies addressing this issue have considerable limitations, such as underpowering, small sample size, lack of randomization, and poor generalizability. A second reason may be the inclusion in the majority of trials of a wide spectrum of MRI-lesions, a scenario in which the benefits of FUS-TB may be less evident. In fact, some of the few studies considering smaller targets demonstrated higher accuracy for the FUS technique. As concerns the advantages of FUS-TB, the opportunity offered by some fusion systems of storing information useful for planning and/or follow-up active surveillance, focal therapy, and radical prostatectomy, as well as a reported faster learning curve, are strong points supporting the fusion approach.In conclusion, the potential advantages when targeting smaller lesions together with the storage capability to guide patient management after the biopsy and an easier learning curve may make the FUS approach the more appropriate technique for performing TB.
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