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Clinical data, PI-RADS, PSA levels, prostate volume, and biopsy outcomes were evaluated. Logistic regression models assessed associations between clinical variables and cancer detection, clinical significance (ISUP\u2009\u2265\u20093), and upgrading after radical prostatectomy (RPE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 496 patients (mean age 66\u2009\u00b1\u20098\u00a0years; PSA, median (IQR): 7.2\u00a0ng\/ml (5\u201310)), cancer was detected in 33% (162\/496), with 29% (47\/162) classified as clinically significant. In our biopsy cohort (PI-RADS 3: 12.7%, PI-RADS 4: 43.0%, PI-RADS 5: 5.6%), clinically significant prostate cancer (ISUP\u2009\u2265\u20093) was detected in 3.2% of PI-RADS 3, 12.2% of PI-RADS 4, and 28.6% of PI-RADS 5 lesions. PI-RADS 5 lesions were strongly associated with cancer detection (OR 3.6, 95% CI 1.35\u201310.13) and significant disease (OR 7.1, 95% CI 1.38\u201355.15), independent of age, prostate volume, and biopsy extent. While these covariates predicted overall biopsy positivity (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.02), they were not associated with significant cancer (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05) or upgrading at RPE (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Among 29 RPE patients, only one was upgraded. Post-biopsy CT was performed in all patients:\u00a0MRI-guided biopsy was associated with a low complication rate: minor localized bleeding occurred in 4.4% of cases, and no major adverse events were observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MRI-guided prostate biopsy showed high diagnostic accuracy and safety in routine care. PI-RADS was the key predictor of clinically significant cancer. The low rate of upgrading after RPE supports its reliability in guiding patient management and avoiding overtreatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance statement<\/jats:title>\n                    <jats:p>MRI-guided prostate biopsy enables accurate detection of clinically significant prostate cancer with low risk of understaging, supporting its routine use in personalized urologic oncology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11255-025-04983-4","type":"journal-article","created":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T06:43:34Z","timestamp":1767422614000},"page":"2491-2501","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transgluteal MRI in-bore prostate biopsy in routine clinical practice: a contemporary-cohort-study from a german tertiary center"],"prefix":"10.1007","volume":"58","author":[{"given":"Thomas","family":"Vogl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Holzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scherwin","family":"Mahmoudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon","family":"Gr\u00fcnewald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vitali","family":"Koch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Gotta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Reschke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Wenzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Hoeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Mandel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Chun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"K\u00f6llermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Bodelle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Erik","family":"Scholtz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renate","family":"Hammerstingl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatjana","family":"Gruber-Rouh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Eichler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Wild","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Bernatz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"issue":"3","key":"4983_CR1","first-page":"229","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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