ArticleInternational urology and nephrology2026
The importance of targeted plus perilesional prostate biopsy in prostate cancer management (diagnosis and treatment)-real world evidence of a tertiary centre.
Article in International urology and nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate whether systematic contralateral biopsy can be safely omitted in men with MRI-detected prostate lesions (PI-RADS ≥ 3) and to assess the impact of contralateral findings on treatment decisions. MATERIALS AND
methodsA retrospective cohort of 617 patients with pre-biopsy multiparametric MRI showing at least one PI-RADS ≥ 3 lesion underwent cognitive MRI-targeted biopsy of the index lesion, perilesional sampling (≥ 6 cores), and contralateral systematic biopsy (≥ 6 cores). Primary endpoint was upgrading in the contralateral lobe versus index/perilesional regions. Secondary endpoint was the impact of contralateral biopsy omission on treatment decision. Statistical analyses included Friedman's test, Wilcoxon signed-rank, one-way ANOVA with Games-Howell, and McNemar's test.
resultsMedian age was 69 years, median PSA 7.83 ng/mL, and median prostate volume 46 cc. Positive cores were observed in 76.3%, 83.3%, and 51.9% of index, perilesional, and contralateral biopsies, respectively. Contralateral lobe ISUP grade was significantly lower than the maximum index/perilesional grade (median 1 vs 2, p < 0.001). Clinically significant prostate cancer (ISUP ≥ 2) was present in 81% of index/perilesional regions versus 39% of contralateral. Only 2.1% of patients had clinically significant cancer isolated to the contralateral lobe (number needed to test = 48). Contralateral findings altered management in 6.3% of cases, predominantly in patients with low-risk features.
conclusionsTumor burden is predominantly localized to the index and perilesional regions. Contralateral biopsy minimally contributes to detecting high-grade disease or modifying treatment decisions. A selective MRI-directed approach combining targeted and perilesional sampling with judicious contralateral biopsy may optimize diagnostic yield while reducing procedural burden.
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