Individualized Decision Making in Transperineal Prostate Biopsy: Should All Men Undergo an Additional Systematic Biopsy?

Abstract

In the last few years, multiparametric magnetic resonance imaging (mpMRI) has been implemented in the diagnostic prostate cancer pathway for the identification of cancerous lesions, and consecutively, targeted fusion biopsy was implemented. In some cases, aggressive prostate cancer is missed by a targeted biopsy. To address this imperfection, additional systematic biopsy is recommended but may be harmful in terms of the additional diagnosis of indolent cancer, and the higher frequency of adverse events and resource expenditures. This study investigates whether all men should undergo an additional systematic biopsy within this clinically relevant trade-off. As a key finding, men with an mpMRI-lesion classified as PI-RADS 5 may obviate additional systematic biopsy. This was confirmed when we analyzed histopathological reclassification rates between biopsy and a subsequent radical prostatectomy.