Conventional Cognitive Freehand versus Software-Supported, Volumetric-Optimized Systematic Ultrasound-Guided Prostate Biopsy: A Head-to-Head Comparison

Introduction: Routine systematic prostate biopsy still is recommended beside targeted biopsies, since without it, a significant proportion of prostate cancer (PCa) will be missed. Out of the various methods, we investigated two in a head-to-head comparison: the volumetric-optimized software-supported (VOT) and the conventional cognitive freehand (CFT) ultrasound-guided systematic prostate biopsy. Methods: This is a retrospective analysis within a consecutive cohort of men undergoing prostate biopsy between 2014 and 2023. Baseline characteristics, diagnostic performance in detecting PCa with corresponding relative risks, have been assessed. Results: A total of 573 patients have been included into analysis: 135 in the CFT and 438 in the VOT group. In the CFT group, 25 (18.5%) showed positive with significant PCa (defined as Gleason Score ≥7), and in the VOT group 125 (28.5%), respectively. The relative risk for the diagnosis of significant cancer was statistically significantly higher in the VOT compared to the CFT group with a relative risk of 1.54 (95% CI from 1.05 to 2.26), whereas the relative risk for insignificant cancer was almost identical. Conclusion: Our results showed that VOT has better diagnostic performance than CFT in detecting significant PCa (defined as Gleason Score ≥7). Taking the study limitations into consideration, the corroboration of our results in other cohorts would promote their generalizability.