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Purpose <p>To evaluate whether systematic contralateral biopsy can be safely omitted in men with MRI-detected prostate lesions (PI-RADS ≥ 3) and to assess the impact of contralateral findings on treatment decisions.</p> Materials and methods <p>A retrospective cohort of 617 patients with pre-biopsy multiparametric MRI showing at least one PI-RADS ≥ 3 lesion underwent cognitive MRI-targeted biopsy of the index lesion, perilesional sampling (≥ 6 cores), and contralateral systematic biopsy (≥ 6 cores). Primary endpoint was upgrading in the contralateral lobe versus index/perilesional regions. Secondary endpoint was the impact of contralateral biopsy omission on treatment decision. Statistical analyses included Friedman’s test, Wilcoxon signed-rank, one-way ANOVA with Games–Howell, and McNemar’s test.</p> Results <p>Median age was 69&#xa0;years, median PSA 7.83&#xa0;ng/mL, and median prostate volume 46&#xa0;cc. Positive cores were observed in 76.3%, 83.3%, and 51.9% of index, perilesional, and contralateral biopsies, respectively. Contralateral lobe ISUP grade was significantly lower than the maximum index/perilesional grade (median 1 vs 2, p &lt; 0.001). Clinically significant prostate cancer (ISUP ≥ 2) was present in 81% of index/perilesional regions versus 39% of contralateral. Only 2.1% of patients had clinically significant cancer isolated to the contralateral lobe (number needed to test = 48). Contralateral findings altered management in 6.3% of cases, predominantly in patients with low-risk features.</p> Conclusions <p>Tumor burden is predominantly localized to the index and perilesional regions. Contralateral biopsy minimally contributes to detecting high-grade disease or modifying treatment decisions. A selective MRI-directed approach combining targeted and perilesional sampling with judicious contralateral biopsy may optimize diagnostic yield while reducing procedural burden.</p>

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The importance of targeted plus perilesional prostate biopsy in prostate cancer management (diagnosis and treatment)—real world evidence of a tertiary centre

  • 期刊论文

  • 发表日期：

    2026年1月24日

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  • Samuel Silva Bastos,
  • Vítor Oliveira,
  • Jorge Dias,
  • Luís Xambre,
  • Ana Sabença,
  • Rui Maciel,
  • Miguel Lourenço,
  • João Peralta

摘要

Purpose

To evaluate whether systematic contralateral biopsy can be safely omitted in men with MRI-detected prostate lesions (PI-RADS ≥ 3) and to assess the impact of contralateral findings on treatment decisions.

Materials and methods

A retrospective cohort of 617 patients with pre-biopsy multiparametric MRI showing at least one PI-RADS ≥ 3 lesion underwent cognitive MRI-targeted biopsy of the index lesion, perilesional sampling (≥ 6 cores), and contralateral systematic biopsy (≥ 6 cores). Primary endpoint was upgrading in the contralateral lobe versus index/perilesional regions. Secondary endpoint was the impact of contralateral biopsy omission on treatment decision. Statistical analyses included Friedman’s test, Wilcoxon signed-rank, one-way ANOVA with Games–Howell, and McNemar’s test.

Results

Median age was 69 years, median PSA 7.83 ng/mL, and median prostate volume 46 cc. Positive cores were observed in 76.3%, 83.3%, and 51.9% of index, perilesional, and contralateral biopsies, respectively. Contralateral lobe ISUP grade was significantly lower than the maximum index/perilesional grade (median 1 vs 2, p < 0.001). Clinically significant prostate cancer (ISUP ≥ 2) was present in 81% of index/perilesional regions versus 39% of contralateral. Only 2.1% of patients had clinically significant cancer isolated to the contralateral lobe (number needed to test = 48). Contralateral findings altered management in 6.3% of cases, predominantly in patients with low-risk features.

Conclusions

Tumor burden is predominantly localized to the index and perilesional regions. Contralateral biopsy minimally contributes to detecting high-grade disease or modifying treatment decisions. A selective MRI-directed approach combining targeted and perilesional sampling with judicious contralateral biopsy may optimize diagnostic yield while reducing procedural burden.