{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:30:53Z","timestamp":1791570653829,"version":"4.3.4"},"reference-count":34,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: It remains unclear whether certain areas of the prostate are more difficult to accurately sample using MRI\/US-fusion-guided freehand single-access transperineal prostate biopsy (FSA-TP). The aim of this study was to evaluate the detection rates of clinically significant (cs) and clinically insignificant (ci) prostate cancer (PCa) in each prostate zone during FSA-TP MRI-target biopsies (MRI-TBs) and systematic biopsies (SB). Methods: This monocentric observational study included a cohort of 277 patients with no prior history of PCa who underwent 3 MRI-TB cores and 14 SB cores with an FSA-TP from January to December 2023. The intraclass correlation coefficient (ICC) was assessed to evaluate the correlation between the Prostate Imaging\u2013Reporting and Data System (PI-RADS) of the index lesion and the International Society of Urological Pathology (ISUP) grade stratified according to prostate zone and region of index lesion at MRI. Multivariate logistic regression analysis was conducted to identify factors associated with PCa and csPCa in patients with discordant results between MRI-TB and SB. Results: FSA-TP-MRI-TB demonstrated higher detection rates of both ciPCa and csPCa in the anterior, apical, and intermediate zones when each of the three MRI-TB cores was analysed separately (p &lt; 0.01). However, when all MRI-TB cores were combined, no significant differences were observed in detection rates across prostate zones (apex, mid, base; p = 0.57) or regions (anterior vs. posterior; p = 0.34). Concordance between radiologic and histopathologic findings, as measured by the intraclass correlation coefficient (ICC), was similar across all zones (apex ICC: 0.33; mid ICC: 0.34; base ICC: 0.38) and regions (anterior ICC: 0.42; posterior ICC: 0.26). Univariate analysis showed that in patients with PCa detected on SB but with negative MRI-TB, older age was the only significant predictor (p = 0.04). Multivariate analysis revealed that patients with PCa detected on MRI-TB but with negative SB, only PSA remained a significant predictor (OR 1.2, 95% CI 1.1\u20131.4; p = 0.01). In cases with csPCa detected on MRI-TB but with negative SB, age (OR: 1.0, 95% CI 1.0\u20131.1; p = 0.02), positive digital rectal examination (OR: 2.0, 95% CI 1.1\u20133.8; p = 0.03), PI-RADS score &gt;3 (OR: 4.5, 95% CI 1.7\u201312.1; p &lt; 0.01), and larger lesion size (OR: 1.1, 95% CI 1.1\u20131.2; p &lt; 0.01) were significant predictors. Conclusions: FSA-TP using 14 SB cores and 3 MRI-TB cores ensures comprehensive sampling of all prostate regions, including anterior and apical zones, without significant differences in detection rates between nodules across different zones. Only in a small percentage of patients was csPCa detected exclusively by SB, highlighting the small but important complementary value of combining SB and MRI-TB.<\/jats:p>","DOI":"10.3390\/cancers17132206","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T11:37:51Z","timestamp":1751283471000},"page":"2206","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Detection Rates of Prostate Cancer Across Prostatic Zones Using Freehand Single-Access Transperineal Fusion Biopsies"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1848-584X","authenticated-orcid":false,"given":"Filippo","family":"Carletti","sequence":"first","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Reitano","sequence":"additional","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora Martina","family":"Toffoletto","sequence":"additional","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Tumminello","sequence":"additional","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Tonet","sequence":"additional","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Basso","sequence":"additional","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5552-8878","authenticated-orcid":false,"given":"Martina","family":"Bruniera","sequence":"additional","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Cacco","sequence":"additional","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Rebaudengo","sequence":"additional","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Saggionetto","sequence":"additional","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Betto","sequence":"additional","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4693-5058","authenticated-orcid":false,"given":"Giacomo","family":"Novara","sequence":"additional","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Dal Moro","sequence":"additional","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4178-373X","authenticated-orcid":false,"given":"Fabio","family":"Zattoni","sequence":"additional","affiliation":[{"name":"Department Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padua, 35126 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/j.eururo.2014.08.079","article-title":"Multifocality and Prostate Cancer Detection by Multiparametric Magnetic Resonance Imaging: Correlation with Whole-mount Histopathology","volume":"67","author":"Le","year":"2015","journal-title":"Eur. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1148\/radiol.2017152877","article-title":"What are we missing? False- negative cancers at multiparametric MR imaging of the prostate","volume":"286","author":"Borofsky","year":"2018","journal-title":"Radiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.eururo.2020.03.048","article-title":"Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta-analysis","volume":"78","author":"Sathianathen","year":"2020","journal-title":"Eur. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/j.eururo.2016.08.003","article-title":"EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent","volume":"71","author":"Mottet","year":"2017","journal-title":"Eur. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.eururo.2016.12.006","article-title":"Why and Where do We Miss Significant Prostate Cancer with Multi-parametric Magnetic Resonance Imaging followed by Magnetic Resonance-guided and Transrectal Ultrasound-guided Biopsy in Biopsy-na\u00efve Men?","volume":"71","author":"Schouten","year":"2017","journal-title":"Eur. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.euo.2023.08.001","article-title":"Is There an Impact of Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Biopsy in Clinically Significant Prostate Cancer Detection Rate? A Systematic Review and Meta-analysis","volume":"6","author":"Uleri","year":"2023","journal-title":"Eur. Urol. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1038\/s41391-023-00729-4","article-title":"Transperineal magnetic resonance imaging targeted biopsy versus transrectal route in the detection of prostate cancer: A systematic review and meta-analysis","volume":"27","author":"Wu","year":"2024","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Osama, S., Serboiu, C., Taciuc, I.A., Angelescu, E., Petcu, C., Priporeanu, T.A., Marinescu, A., and Costache, A. (2024). Current Approach to Complications and Difficulties during Transrectal Ultrasound-Guided Prostate Biopsies. J. Clin. Med., 13.","DOI":"10.3390\/jcm13020487"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e70016","DOI":"10.1002\/bco2.70016","article-title":"Transperineal prostate biopsy with freehand technique under local anaesthetic: A systematic review and meta-analysis","volume":"6","author":"Calpin","year":"2025","journal-title":"BJUI Compass"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.cpt.2022.12.001","article-title":"Freehand transperineal prostate biopsy with a coaxial needle under local anesthesia: Experience from a single institution in Malaysia","volume":"1","author":"Ngu","year":"2023","journal-title":"Cancer Pathog. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"15579883241302045","DOI":"10.1177\/15579883241302045","article-title":"The Role of Freehand Transperineal Prostate Biopsy Under Local Anesthesia Without Antibiotics in Outpatient Settings","volume":"18","author":"Tang","year":"2024","journal-title":"Am. J. Mens. Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1016\/j.euo.2024.07.009","article-title":"Transperineal Versus Transrectal Magnetic Resonance Imaging\u2013targeted Prostate Biopsy: A Systematic Review and Meta-analysis of Prospective Studies","volume":"7","author":"Zattoni","year":"2024","journal-title":"Eur. Urol. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Paesano, N., Picola, N., Mu\u00f1oz-Rodriguez, J., Ruiz-Plazas, X., Mu\u00f1oz-Rivero, M.V., Celma, A., Garc\u00eda-de Manuel, G., Mir\u00f3, B., Servian, P., and Abascal, J.M. (2025). Efficacy of Prostate Biopsies via Transperineal and Transrectal Routes for Significant Prostate Cancer Detection: A Multicenter Paired\u2013Matched Study. Diagnostics, 15.","DOI":"10.20944\/preprints202501.0409.v1"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.euros.2024.05.009","article-title":"Enhancing Prostate Cancer Detection Accuracy in Magnetic Resonance Imaging\u2013targeted Prostate Biopsy: Optimizing the Number of Cores Taken","volume":"66","author":"Zattoni","year":"2024","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.eururo.2024.03.027","article-title":"EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer","volume":"86","author":"Cornford","year":"2024","journal-title":"Eur. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.eururo.2019.02.033","article-title":"Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2","volume":"76","author":"Turkbey","year":"2019","journal-title":"Eur. Urol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5404","DOI":"10.1007\/s00330-020-06929-z","article-title":"ESUR\/ESUI consensus statements on multi-parametric MRI for the detection of clinically significant prostate cancer: Quality requirements for image acquisition, interpretation and radiologists\u2019 training","volume":"30","author":"Tummers","year":"2020","journal-title":"Eur. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1097\/JU.0000000000002802","article-title":"The Detection of Prostate Cancer with Magnetic Resonance Imaging-Targeted Prostate Biopsies is Superior with the Transperineal vs the Transrectal Approach. A European Association of Urology-Young Academic Urologists Prostate Cancer Working Group Multi-Ins","volume":"208","author":"Zattoni","year":"2022","journal-title":"J. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1089\/end.2020.1093","article-title":"Free-hand\u201d transperineal prostate biopsy under local anesthesia: Review of the literature","volume":"35","author":"Szabo","year":"2021","journal-title":"J. Endourol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Pacini, M., Zucchi, A., Morganti, R., Dazzi, F., Pastore, A.L., Valenzi, F.M., Fuschi, A., al Salhi, Y., Giannarini, G., and Ficarra, V. (2025). Correlation of clinically significant prostate cancer sites across multiparametric MRI, prostate biopsy, and whole-mount pathology for optimal prostate biopsy strategy. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-88463-w"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1002\/bco2.178","article-title":"Pooled outcomes of performing freehand transperineal prostate biopsy with the PrecisionPoint Transperineal Access System","volume":"3","author":"Tzeng","year":"2022","journal-title":"BJUI Compass"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"883","DOI":"10.21037\/tau-2024-754","article-title":"Choosing the path: Insights into transperineal vs. transrectal prostate biopsy","volume":"14","author":"Hsu","year":"2025","journal-title":"Transl. Androl. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3009","DOI":"10.21037\/tau.2019.12.40","article-title":"Transperineal prostate biopsy: A review of technique","volume":"9","author":"Thomson","year":"2021","journal-title":"Transl. Androl. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/S1470-2045(25)00100-7","article-title":"Local anaesthetic transperineal biopsy versus transrectal prostate biopsy in prostate cancer detection (TRANSLATE): A multicentre, randomised, controlled trial","volume":"26","author":"Bryant","year":"2025","journal-title":"Lancet Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e33","DOI":"10.1016\/j.clgc.2016.07.007","article-title":"Transperineal Versus Transrectal MRI\/TRUS Fusion Targeted Biopsy: Detection Rate of Clinically Significant Prostate Cancer","volume":"15","author":"Pepe","year":"2017","journal-title":"Clin. Genitourin. Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1097\/JU.0000000000001234","article-title":"Pain in Men Undergoing Transperineal Free-Hand Multiparametric Magnetic Resonance Imaging Fusion Targeted Biopsies under Local Anesthesia: Outcomes and Predictors from a Multicenter Study of 1,008 Patients","volume":"204","author":"Marra","year":"2020","journal-title":"J. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1038\/s41391-019-0201-y","article-title":"Feasibility of freehand MRI\/US cognitive fusion transperineal biopsy of the prostate in local anaesthesia as in-office procedure\u2014Experience with 400 patients","volume":"23","author":"Wetterauer","year":"2020","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"He, B.M., Chen, R., Shi, Z.K., Xiao, G.A., Li, H.S., Lin, H.Z., Ji, J., Peng, H.-X., Wang, Y., and Sun, Y.-H. (2019). Trans-perineal template-guided mapping biopsy vs. Freehand trans-perineal biopsy in chinese patients with PSA < 20 ng\/ml: Similar cancer detection rate but different lesion detection rate. Front. Oncol., 9.","DOI":"10.3389\/fonc.2019.00758"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1097\/JU.0000000000001902","article-title":"Freehand versus Grid-Based Transperineal Prostate Biopsy: A Comparison of Anatomical Region Yield and Complications","volume":"206","author":"Urkmez","year":"2021","journal-title":"J. Urol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"269","DOI":"10.5152\/tud.2025.24026","article-title":"Freehand Transperineal Prostate Biopsy Improves the Detection Rate of Clinically Significant Prostate Cancer","volume":"50","author":"Bujaldon","year":"2025","journal-title":"Urol. Res. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.euros.2025.03.008","article-title":"Targeting All Multiple Magnetic Resonance Imaging Prostate Lesions Does Not Enhance Cancer Detection: Insights from the YAU Prostate Cancer Group","volume":"75","author":"Zattoni","year":"2025","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1038\/s41391-023-00733-8","article-title":"Role of targeted biopsy, perilesional biopsy, random biopsy, and their combination in the detection of clinically significant prostate cancer by mpMRI\/transrectal ultrasonography fusion biopsy in confirmatory biopsy during active surveillance program","volume":"27","author":"Novara","year":"2024","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.eururo.2022.01.008","article-title":"Targeted Prostate Biopsy: Umbra, Penumbra, and Value of Perilesional Sampling","volume":"82","author":"Brisbane","year":"2022","journal-title":"Eur. Urol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/13\/2206\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:01:49Z","timestamp":1760032909000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/13\/2206"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,30]]},"references-count":34,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["cancers17132206"],"URL":"https:\/\/doi.org\/10.3390\/cancers17132206","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,30]]}}}