Clinical significance of the combined systematic 12-core with concomitant MRI image-guided targeted prostate biopsy: can the MRI targeted biopsy stand on its own?

To determine whether magnetic resonance imaging (MRI) image-guided biopsy (Targeted Bx) is accurate enough to replace the Combined Targeted Bx and systematic template 12-core transrectal ultrasound-guided prostate biopsy (Systematic Bx) in the detection of clinically significant prostate cancer (csPCA, Gleason score > 6), and if Targeted Bx alone significantly outperforms Systematic Bx.

Data were collected retrospectively from all patients with MRI Prostate Image Reporting and Data System (PIRADS) level 3 and above that received a Combined Targeted Bx and Systematic Bx from 11/1/22 to 6/8/23 at Virginia Urology, a large community urology group. Patient information was entered into a database and analyzed using Chi-square and t-test.

A total of 474 patients were identified. MRI results showed that 152 (32.1%) cases were PIRADS 3, 218 (46.0%) cases were PIRADS 4, and 104 (21.9%) cases were PIRADS 5. Overall, the combined targeted and systematic biopsy (Combined Bx) detected more clinically significant PCA (294, 62.0%) than the Systematic Bx (231, 48.7%) or Targeted Bx (237, 50.0%) did alone. Isolation of PIRADS 5 alone showed clinical insignificance in the combined biopsy versus the targeted biopsy alone. The systematic and targeted methods are insignificantly different from each other (P > 0.05), across all PIRADS levels.

Combined systematic and targeted biopsy was significantly better in the diagnosis of csPCA across PIRADS 3 to 5. For patients with PIRADS 5, combined biopsies were not significantly different from targeted biopsies. We determined that we could not remove the systematic biopsy from our current technique. Additionally, systematic biopsies still perform well in the detection of csPCA.