The role of perilesional sampling in the era of targeted prostate biopsy: A scoping review

Multiparametric MRI (mpMRI) has reshaped prostate cancer diagnosis. However, Multiparametric MRI (mpMRI) often underestimates the tumor extent. Perilesional biopsy (PB) helps avoid excessive numbers of systematic biopsy (SB) cores. Nevertheless, there are concerns about the potential misses of contralateral clinically significant prostate cancer (csPCa). Despite ongoing research, a lack of high-quality studies remains. This scoping review examined the impact of PB in detecting csPCa, as well as the potential advantages and drawbacks of perilesional sampling compared to TB and systematic biopsy (SB) approaches. We conducted a PRISMA-based systematic search in Pubmed, Scopus, and WOS. We identified 77 articles, and nineteen PB studies were selected. Fourteen studies utilized an MRI-TRUS fusion software. Ten applied a sector-based or quadrant-based definition of perilesional sampling, and 8 adopted a precise mm-based definition, within a 5 mm or a ≤ 10 mm perilesional margin. We discovered a significant methodological diversity, particularly in terms of direct comparisons. Included studies recorded a wide range of csPCa detection rates (35%-99%). There were contradictory findings regarding the impact of PB on the detection rates of csPCa. Adding PB to TB decreased the detection of insignificant prostate cancer, the number of biopsy cores, and the upgrading rates in radical prostatectomy specimens. Six and 13 studies were rated as high- and moderate-risk of overall bias according to the ROBINS-I framework. Perilesional sampling during prostate biopsy is a promising yet immature strategy for detecting csPCa. The heterogeneity of methods and the lack of a standardized protocol hinder widespread adoption.