Is there still a role for systematic biopsy after targeted biopsy for the detection of clini-cally significant prostate cancer in MRI suspicious lesions?

purposeThe combination of systematic biopsy (SB) and MRI-targeted biopsy (TB) is the current approach for prostate cancer (PCa) diagnosis; however, the clinical benefit of including SB remains controversial. This study aimed to determine whether SB adds value beyond TB in detecting clinically significant prostate cancer (csPCa) in men with suspicious lesions. MATERIALS AND

methodsRetrospective, single-center study conducted between January 2019 and September 2023. It enrolled men with suspicious lesions identified on multiparametric MRI (PI-RADS≥3) who had undergone combined biopsy (TB+SB). Sociodemographic and clinical data were secondarily collected. csPCa was defined when ISUP≥2.

resultsThis study included 997 men with a median age of 68 years, of whom 497 had a negative prior biopsy. The TB+SB approach identified 53.0% of PCa and 36.8% of csPCa cases. TB alone significantly outperformed SB in identifying csPCa, with detection rates of 34.8% vs. 10.3%, respectively, missing only 4.8% of PCa diagnosis-most of which were low-grade tumors. SB contributed marginally, identifying additional csPCa cases in 1.4% of patients. In patients with a prior negative biopsy, the addition of SB to TB only accounted for 12.5% of PCa diagnosis. Limitations include the study single-center design, restricting generalizability, and the lack of whole-mount prostatectomy for histological confirmation.

conclusionsIn conclusion, SB adds limited diagnostic value, with TB alone being sufficient for detecting csPCa cases in patients with MRI-visible lesions. The results suggest that SB may be safely omitted in selected patients to reduce biopsy burden and lead to better clinical outcomes.