Kaufmann B, Saba K, Schmidli TS, et al. - Prostate cancer (PCa) detection rate of transperineal template-guided saturation prostate biopsy (SBx) and multiparametric magnetic resonance imaging (mpMRI)/transrectal ultrasound fusion guided targeted biopsy (TBx) were compared; findings revealed that TBx alone, vs SBx, identifies clinically significant PCa (csPCa) in only ¾ of all males with a positive mpMRI lesion. Therefore, consideration should be given to systematic biopsies in addition to TBx at least in some who undergo a prostate biopsy.

• This study included 392 men, with a median age of 64 years, who had SBx and TBx in case of suspicious lesions from November 2016 to October 2019.

• Of all biopsied men, 51% were found to have PCa, with 79% being csPCa and 21% clinically insignificant PCa (ciPCa).

• Of men with a suspicious mpMRI and underwent a combined TBx and SBx (n=268; 68%), 52% (n=139) were detected with csPCa.

• In this subgroup, 83% csPCa would have been identified through TBx alone, and an additional 17% were detected by SBx.

• In males showing a negative mpMRI, SBx still identifies 15% csPCa, but similarly overdetecting ciPCa.

• Increasing prostate-specific antigen (PSA) (odds ratio, OR: 1.07), increasing age (OR: 1.07), PI-RADS (prostate imaging–reporting and data system) score ≥ 3 (OR: 6.49), and smaller prostate volume (OR: 0.96) were found to be significant predictors of csPCa.

• Low PSA density and negative mpMRI findings could help decide which men can safely avoid biopsy.