Targeted biopsy plus systematic biopsy versus targeted saturation biopsy plus systematic biopsy for the detection of clinically significant prostate cancer: A comparative study

ABSTRACT Introduction: Multiparametric magnetic resonance imaging (mpMRI)-guided targeted biopsy (TB) has improved the detection of clinically significant prostate cancer (csPCa). This study compared the diagnostic performance of TB versus targeted saturation biopsy (TS), both in addition to standard 12-core systematic biopsy (SB), for the detection of csPCa. Methods: This comparative study included men with suspected prostate cancer and mpMRI lesions (Prostate Imaging Reporting and Data System ≥3). Patients underwent either TB (4 cores per lesion) with SB or TS (4 targeted cores plus 4 perilesional cores) with SB. csPCa was defined as Gleason Grade Group ≥2. Detection rates were compared between groups. Continuous variables were compared using the Mann–Whitney U-test and categorical variables using the Chi-square or Fisher’s exact test. Logistic regression analysis was used to identify independent predictors of csPCa. Odds ratios, relative risk, and 95% confidence intervals (CIs) were calculated. Results: A total of 108 patients were analyzed (TB + SB: n = 65; TS + SB: n = 43). csPCa was detected in 56.9% of the TB + SB group and 72.1% of the TS + SB group (P = 0.110). The odds ratio (OR) for csPCa detection comparing TB + SB with TS + SB was 0.51 (95% CI: 0.22–1.17), indicating a clinical advantage with TS biopsy. TS missed no case identified by SB. Complication rates were comparable between groups (P = 0.472). Conclusion: Although the TS biopsy did not demonstrate statistically significant superiority over TB, the higher detection rate and favorable OR suggest a potential clinical benefit. Larger studies with appropriate power and balanced baseline characteristics are needed to confirm these observations.