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Targeted, Perilesional, and Distant Biopsies in Prostate Cancer.

Michael Baboudjian1, Alessandro Uleri2, Julien Anract3

  • 1Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France.

European Urology Oncology
|February 24, 2026
PubMed
Summary
This summary is machine-generated.

For men with prostate cancer visible on MRI, targeted plus perilesional biopsies are effective. The MIRAGE study found that adding distant biopsies offers minimal benefit and can be omitted for better diagnostic yield.

Keywords:
Distant biopsyProstate Imaging Reporting and Data SystemProstate cancerRegional biopsyTargeted biopsy

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Area of Science:

  • Urology
  • Oncology
  • Radiology

Background:

  • Current guidelines recommend targeted plus perilesional biopsies for prostate lesions visible on MRI.
  • Existing data are largely retrospective and lack standardized biopsy protocols.

Purpose of the Study:

  • To prospectively evaluate the diagnostic outcomes of incorporating perilesional biopsies into the standard biopsy protocol.
  • To assess the added value of perilesional and distant biopsies in detecting clinically significant prostate cancer.

Main Methods:

  • Prospective, observational, multicenter study (MIRAGE) involving 912 men with PI-RADS ≥3 lesions.
  • Mandated targeted and perilesional biopsies; distant biopsies were optional.
  • Calculated detection rates for Gleason grade (GG) group ≥2 and GG group 1 lesions for each biopsy scheme.

Main Results:

  • Targeted biopsy detected GG group ≥2 lesions in 41% of men.
  • Perilesional sampling increased GG group ≥2 detection by 3.6% but also increased GG group 1 detection by 1%.
  • The benefit of perilesional sampling was greatest in biopsy-naïve men and those with PI-RADS 4-5 lesions. Distant biopsies provided minimal additional detection of GG group ≥2 lesions.

Conclusions:

  • The MIRAGE study provides prospective evidence supporting the omission of distant biopsies when using a targeted plus perilesional strategy.
  • This approach optimizes diagnostic yield for clinically significant prostate cancer while minimizing unnecessary sampling.