ArticleInternational urology and nephrology2026
Impact of omitting contralateral systematic biopsy on clinically significant upgrading at radical prostatectomy: a retrospective paired-design study.
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
purposeWhether contralateral systematic biopsy (SB) can be safely omitted when combined with MRI-targeted biopsy (TB) remains debated. This study compared the pathological concordance of TB plus ipsilateral SB (TBI) versus TB plus bilateral SB (TBB) against radical prostatectomy (RP) whole-mount pathology in a Chinese cohort.
methodsIn this paired-design study, 246 Chinese men who underwent transperineal MRI-TRUS fusion combined biopsy followed by RP (2017-2024) were included. Five biopsy strategies (TBB, TBI, SB-only, TB-only, TB+contralateral SB) were retrospectively reconstructed from the same procedure. The major outcomes were clinically significant upgrade (CTC-upgrade: biopsy Grade Group [GG] ≤ 1 → RP GG ≥ 2, including GG0) and any-upgrade (biopsy GG < RP GG). Minor outcomes included exact concordance, any downgrade, high-risk upgrade, and clinically significant downgrade. Paired comparisons used the McNemar test with Bonferroni correction.
resultsCTC-upgrade rates were 13.8% for TBB and 15.0% for TBI (McNemar p = 0.25), with 3 discordant pairs (absolute difference 1.2% [95% CI 0.3-3.5%]). A post-hoc non-inferiority analysis confirmed adequate study power of 0.94 (non-inferiority margin - 5%). TBI showed modestly higher any-upgrade (33.7% vs. 30.9%, p = 0.016). No significant differences were observed across minor outcomes. SB-only, TB-only, and TB+contralateral SB had significantly higher CTC-upgrade rates (24.8%, 24.4%, 21.5%; all p < 0.001 vs. TBB). No subgroup showed a significant CTC-upgrade difference.
conclusionTBI demonstrated broadly similar pathological grade accuracy to TBB. The incremental contribution of contralateral systematic biopsy to clinically significant upgrading was small.
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