Consistency of multiparametric MRI-guided transperineal prostate biopsy and Gleason score after radical...

This study aims to compare the consistency of the Gleason score after radical prostatectomy between cognitive multi-parametric magnetic resonance imaging (mpMRI)-guided transperineal ultrasound-guided transperineal prostate biopsy (TPUS-TPPB), prostate systematic biopsy, and their combined biopsy, and to identify the optimal biopsy approach. This retrospective observational study analyzed 60 patients with prostate cancer who underwent cognitive mpMRI-guided TPUS-TPPB combined with systematic transperineal biopsy in our hospital from August 2021 to May 2023, followed by radical prostatectomy. All patients completed pre-biopsy multiparametric MRI. Using the Gleason score of post-radical prostatectomy specimens as the reference standard, we compared prostate cancer detection rates and Gleason score consistency among targeted biopsy, systematic biopsy, and combined biopsy. The positive detection rate of prostate systematic biopsy was 46.67% (28/60; 95% confidence interval (CI): 33.7%-59.9%), while the detection rate of cognitive mpMRI-guided TPUS-TPPB was 71.67% (43/60; 95% CI: 58.7%-82.1%). After combining both approaches, the detection rate increased to 100.00% (60/60; 95% CI: 94.0%-100.0%). The Gleason score upgrade rate after systematic biopsy was significantly higher than that after combined biopsy (46.67% vs 11.67%; P <.05) and cognitive mpMRI-guided TPUS-TPPB (36.67%; P <.05). There was no significant difference in the Gleason score upgrade rate between combined biopsy and cognitive mpMRI-guided TPUS-TPPB alone (P >.05). Cognitive mpMRI-guided TPUS-TPPB combined with systematic biopsy increases the prostate cancer detection rate and yields Gleason scores that are closer to those of radical prostatectomy specimens. The findings indicate that systematic prostate biopsy retains important complementary value when used alongside targeted biopsy.