Fusion-guided biopsy transformed how clinicians diagnose prostate cancer, giving radiologists and urologists a precise, shared map of suspicious lesions instead of a blind search pattern. Now, image guidance is expanding beyond biopsy into treatment planning and targeted intervention — a shift raising new questions about collaboration, data and technology across the care pathway.
During a recent webinar hosted by Becker’s Healthcare and Philips, Rajan Gupta, MD, professor of radiology and urology and director of imaging at Duke Cancer Institute’s Center for Prostate & Urologic Cancers, and Srinivas Vourganti, MD, director of image-guided focal therapy at Cleveland Clinic’s Glickman Urological & Kidney Institute, joined Philips’ Kevin Coady and Paavo Immonen to discuss what that next phase requires.
Confidence built on quality, not just technology
Gupta said diagnostic confidence in prostate cancer has grown out of standardized imaging quality and validated scoring systems like PI-RADS, paired with ongoing radiology-pathology correlation to check whether a suspected cancer is actually confirmed at biopsy. Vourganti added that before high-quality imaging became widespread, clinicians and patients were prone to overtreatment, since even a small amount of cancer found on biopsy could be “the tip of the iceberg.” Today, reliable imaging gives teams enough certainty to de-escalate care — avoiding an unnecessary biopsy or aggressive treatment for low-risk disease — rather than defaulting to the most aggressive option out of caution.
From a blind search to a breadcrumb trail
Vourganti described the shift from older “search pattern” biopsies — which he compared to a scavenger hunt through a house with no clues — to fusion-guided biopsy, where radiologists build a detailed three-dimensional map ahead of time. That map, he said, cut down significantly on repeat biopsies for cancers that previously evaded the needle. Gupta offered a similar analogy, comparing fusion biopsy to a walkie-talkie: radiology leaves a “beacon” marking where it believes the answer lies, and urology uses that beacon to guide the biopsy.
Breaking down silos between radiology, urology and pathology
Coady described a persistent challenge: the technology for radiology, urology and digital pathology often exists in separate silos, making it hard to pull imaging, biopsy and grading data into one view a urologist can act on. Gupta agreed that patients’ confidence should come from knowing their care is delivered by an integrated team — the best radiologist in the world, disconnected from the urologist, still won’t produce the right answer. Both physicians pointed to multidisciplinary clinic models, where specialists meet as a single group organized around the patient, as one way health systems have addressed the gap.
Where AI is helping — and where adoption still lags
Panelists agreed AI is already improving image acquisition speed and quality and helping triage radiology worklists. Gupta sees even more potential in using AI to upskill clinicians — drawing attention to findings a radiologist might otherwise miss and helping address burnout as patient volume climbs. With roughly one in eight men expected to be diagnosed with prostate cancer, panelists framed AI less as a novelty and more as a necessary way to extend a limited workforce. Coady pointed to a bigger gap on the pathology side: only about 20% of U.S. pathology samples are currently digitized for primary diagnosis, leaving most grading decisions reliant on manual microscope review with known variability between pathologists.
Extending image guidance into treatment
Vourganti described how detailed, pre-procedure imaging has enabled more targeted interventions, including focal therapy that treats only the affected area of the prostate rather than defaulting to broader treatment. Because the prostate sits at the intersection of urinary and sexual function, indiscriminate treatment has historically carried significant side effects; better imaging now gives clinicians “breathing room” to treat just the area involved. He called focal therapy an emerging field still being refined, one requiring the same rigor in measuring outcomes that built confidence in diagnostic imaging.
Looking five years ahead
Asked what leading programs will be doing differently in five years, Gupta pointed to scaling impact without sacrificing quality or outcomes as AI and personalized treatment mature, built on deeper collaboration across departments and with industry partners. Vourganti struck a more measured note, emphasizing the discipline of proving out new approaches through registries and trials rather than assuming newer is automatically better. Coady and Immonen both pointed to the opportunity of linking data across radiology, urology and pathology to build more predictive, end-to-end patient pathways — without replacing the expertise of individual clinicians.
