Clinical radiology · 2026
Software-assisted magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion-guided transperineal prostate biopsy: is there still a need for contralateral systematic biopsy?
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Claerhoudt F, De Vulder N, Libeert A, Gieraerts K, Meersschaert J, Kalmar A, Marrannes J, Dekimpe P, Uvin P, Villeirs G
Аннотация
AIM: Combined biopsy (CBx) of the prostate, integrating magnetic resonance imaging (MRI)-targeted biopsy (TBx) with systematic biopsy (SBx), is widely used for detecting clinically significant prostate cancer (csPCa) but carries a risk of overdiagnosis. This study evaluated whether SBxs contralateral to the MRI target can be omitted in men with unilateral MRI-visible prostate lesions by comparing CBx with targeted biopsy plus ipsilateral systematic biopsy (TBx + SBxIpsi).
MATERIALS AND METHODS: In this prospective, single-centre study, 582 magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion-guided transperineal biopsy sessions were analysed. Inclusion criteria were a single unilateral prostate lesion on MRI, not overlapping the midline, with a Prostate Imaging Reporting and Data System (PI-RADS) v2.1 score of 3-5. Patients underwent CBx, consisting of 5 TBx cores and 10 SBx cores (SBx; 5 per hemigland). Detection rates of csPCa (International Society of Urological Pathology [ISUP] grade group ≥2) and clinically insignificant prostate cancer (cisPCa, ISUP grade group 1) using TBx + SBxIpsi were compared with CBx using McNemar's test with Holm-Bonferroni correction.
RESULTS: A total of 582 men (mean age: 69 ± 9 years) underwent biopsy. CBx detected csPCa in 383 of 582 patients (65.8%; 95% confidence interval [CI]: 61.8-69.7%). TBx + SBxIpsi detected csPCa in 381 of 582 patients (65.5%; 95% CI: 61.4-69.3%), identifying 99.5% of csPCa cases detected by CBx, with no statistically significant difference (P=0.4795). Detection of cisPCa was lower with TBx + SBxIpsi than with CBx (80/582 vs. 87/582; P=0.0455).
CONCLUSION: Omitting SBxs contralateral to the MRI target maintains comparable csPCa detection while reducing cisPCa detection and the number of biopsy cores.
MATERIALS AND METHODS: In this prospective, single-centre study, 582 magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion-guided transperineal biopsy sessions were analysed. Inclusion criteria were a single unilateral prostate lesion on MRI, not overlapping the midline, with a Prostate Imaging Reporting and Data System (PI-RADS) v2.1 score of 3-5. Patients underwent CBx, consisting of 5 TBx cores and 10 SBx cores (SBx; 5 per hemigland). Detection rates of csPCa (International Society of Urological Pathology [ISUP] grade group ≥2) and clinically insignificant prostate cancer (cisPCa, ISUP grade group 1) using TBx + SBxIpsi were compared with CBx using McNemar's test with Holm-Bonferroni correction.
RESULTS: A total of 582 men (mean age: 69 ± 9 years) underwent biopsy. CBx detected csPCa in 383 of 582 patients (65.8%; 95% confidence interval [CI]: 61.8-69.7%). TBx + SBxIpsi detected csPCa in 381 of 582 patients (65.5%; 95% CI: 61.4-69.3%), identifying 99.5% of csPCa cases detected by CBx, with no statistically significant difference (P=0.4795). Detection of cisPCa was lower with TBx + SBxIpsi than with CBx (80/582 vs. 87/582; P=0.0455).
CONCLUSION: Omitting SBxs contralateral to the MRI target maintains comparable csPCa detection while reducing cisPCa detection and the number of biopsy cores.