A Triple Clinical Filter Model for Selective Omission of Systematic Cores in Transperineal Cognitive Prostate Biopsy: A Retrospective Observational Study
Prostate, cilt.86, sa.14, ss.1421-1427, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 86 Sayı: 14
- Basım Tarihi: 2026
- Doi Numarası: 10.1002/pros.70223
- Dergi Adı: Prostate
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, MEDLINE, Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Sayfa Sayıları: ss.1421-1427
- Anahtar Kelimeler: antibiotic-free, cognitive fusion biopsy, prostate cancer, systematic biopsy, targeted biopsy, transperineal
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: To determine whether systematic biopsy can be safely omitted in selected patients undergoing antibiotic-free transperineal cognitive MRI-targeted prostate biopsy under local anesthesia, and to identify clinical and imaging parameters associated with cognitive biopsy superiority. Methods: This retrospective study included patients who underwent antibiotic-free transperineal prostate biopsy under local anesthesia. All patients had multiparametric prostate MRI (mpMRI) visible lesions and received both systematic and cognitive MRI-targeted biopsy. Targeted cores were obtained from all PI-RADS 4–5 lesions and from PI-RADS 3 lesions only when PSA density was ≥ 0.10 ng/mL/cm3. Cognitive biopsy non-inferiority was defined as an ISUP Grade Group equal to or higher than that obtained from systematic cores in the same patients. PSA density, MRI lesion size, and PI-RADS category were incorporated into a multivariable model to predict when systematic sampling would not add diagnostic value. Results: The multivariable model incorporating PSA density, MRI lesion size, and PI-RADS category demonstrated good discriminatory performance (AUC 0.881, sensitivity 92.6%, specificity 84.8%). In patients meeting all predefined model criteria, cognitive biopsy achieved concordant or superior grading in 95.2% of cases, whereas in those not meeting these criteria, systematic biopsy provided higher-grade detection in all cases within this subgroup. Conclusions: In carefully selected patients with elevated PSA density, larger mpMRI visible lesions, and high PI-RADS scores, transperineal cognitive MRI-targeted biopsy may support the selective omission of systematic cores without compromising diagnostic reliability. In contrast, systematic sampling remains indispensable in lower-risk profiles, underscoring the value of a risk-adapted biopsy strategy.