Abstract

Introduction: We aimed to compare the detection rate of prostate cancer (PCa) and clinically significant (cs)PCa by magnetic resonance imaging-guided targeted biopsy (MTBx) alone and MTBx plus systematic biopsy (SBx) using an outpatient transperineal (TP) approach under local anesthesia. Methods: A retrospective study of patients who underwent outpatient TP prostate biopsy under local anesthesia at our tertiary institution between 2019 and 2022 was performed. To compare the proportions of PCa and csPCa in both pathways, McNemar's tests were used. Multivariable logistic regression model was fitted to determine the predictors of csPCa. Results: Of 255 men included, 177 (69%) underwent MTBx alone. MTBx had similar detection rate for PCa (56%) and csPCa (47%) compared to the combination of MTBx and SBx (PCa, 61%; csPCa, 49%; p=0.1 and p=0.3, respectively). MTBx had lower median number of biopsy cores compared to the combination of MTBx and SBx (6 vs. 11, p<0.001). At multivariable logistic regression analysis, age (odds ratio [OR] 1.08 [1.04–1.13], p<0.001), prior negative biopsy (OR 0.19 [0.09–0.44], p<0.001), prostate-specific antigen density cutoff ≥ 0.15 (OR 3.17 [1.67–6.01], p<0.001), and prostate imaging reporting and data system ≥4 (OR 12.2 [4.21–35.6], p<0.001) were independent predictors of csPCa. Conclusions: MTBx showed similar diagnostic performance to the combination of MTBx and SBx in patients undergoing outpatient TP prostate biopsy. Future studies are needed to evaluate the role of MTBx in avoiding unnecessary biopsies.