Targeted Versus Targeted Plus Random Transperineal Prostate Biopsy in patients with a single lesion on MRI: Is There Added Value?

Background : Standardization of multi-parametric MRI (mp-MRI) prior to prostate biopsy and the incorporation of ultrasound fusion allowed precise and accurate targeted prostate biopsies. Random biopsies, still performed as routine, are taken from the ipsilateral and contralateral side of the prostatic lesion. We aim to determine the added value of systematic biopsies (SB) compared to targeted biopsy (TB) only in patients with a single lesion on mp-MRI. Methods : From July 2019 to January 2024, 196 of 464 patients had a single unilateral MRI lesion underwent target and random biopsy under MRI-Ultrasound fusion using KOELIS Trinity ^® MRI TPUS Biopsy. Biopsy results of TB alone, SB (targeted and random biopsies from both sides), TB+ipsilateral random biopsy (TB+ipsi), and TB+contralateral random biopsy (TB+contra) were analyzed. Gleason score and Grade group system (1-5) were utilized. Clinically significant PCa (csPCa) was defined as Gleason score > 6 or Grade Group ≥ 2. McNemar test was used to compare Cancer detection between these groups in addition to cancer detection in each Grade Group and PIRADS score. Result : Prostate cancer detection rate in TB alone was 54.6% compared to SB (58.7%) (p= 0.005). Also, TB+ipsi had a detection rate of 56.6% (p= 0.046) and TB+contra of 57.1% p=0.025 when compared to TB alone. For csPCa, only SB and TB+contra showed significant increase in cancer detection (p value: SB= 0.01, TB+contra=0.046) when compared to TB alone. When comparing TB, SB, TB+Ipsi, TB+contra according to the PIRADS score of the single lesion, there was no significant difference in patients with a single PIRADS 5 or PIRADS 3 lesion. However, there was significance in PIRADS 4 lesions (p=0.014), in SB (52.7%) compared to TB (44.6%). Conclusion : SB and TB+contra seem to have a benefit in diagnosis of csPCa in patients with a single lesion detected on mp-MRI. SB seems to have a significant benefit in the diagnosis of prostate cancer in patients with a single PIRADS 4 lesion on mp-MRI. There is no benefit from taking random biopsies in patients with a single PIRADS 5 lesion.