Multicentre assessment of transperineal targeted prostate biopsy performed as part of a targeted and systematic biopsy diagnostic strategy in men without previous prostate biopsies

Objective
To investigate the added value of systematic biopsies in men referred with suspected PCa undergoing visual registration targeted local anaesthetic transperineal prostate biopsies (LATPB) as their first biopsy for MRI-P visible lesions (MRI Score≥3) in a real-world setting.

Patients and methods
The outcomes of 2611 biopsy naïve men with MRI Score≥3 who underwent visual registration combined targeted and systematic LATPB at 5 hospitals between 2021 and 2024 were studied. The primary outcome was the clinically significant PCa (csPCa [Gleason≥ 3 + 4 = 7])) cancer detection rate at targeted prostate biopsy without upgrading contributed by the systematic component of the biopsies.

Results
Overall, PCa was diagnosed in 2079/2611 (80%) patients. The targeted biopsy csPCa detection rate in MRI Score 3,4 and 5 lesions was 108/534 (20%), 461/940 (49%) and 865/1137 (76%), respectively. The csPCa detection rate for combined biopsies in MRI Score 3, 4 and 5 lesions was 150/534 (28%), 579/940 (62%) and 959/1137 (84%). The NPV for targeted biopsies for MRI scores 3,4 and 5 lesions were 81.7%, 95% CI = (78.0%, 84.9%), 68.4%, 95% CI = (63.5%, 73.0%) and 55.7%, 95% CI = (48.0%, 63.1%), respectively. Increasing PSA-D was strongly associated with increased detection of csPCa at targeted prostate biopsy irrespective of MRI score (chi-square test p < 0.001).

Conclusions
An MRI-P and targeted prostate biopsy-only approach should be considered in all biopsy naïve men with MRI score 5 lesions and MRI score 4 lesions with a PSA Density greater than 0.15.

Patient summary
We looked at the difference between sampling a specific area of interest identified by prostate MRI compared to sampling the area of interest and additionally the prostate zones. In our study, we concluded that sampling the area of interest guided by the MRI scan alone can be more beneficial with less risk of missing out on clinically important prostate cancer in real-life practice.