{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T14:09:19Z","timestamp":1778767759613,"version":"3.51.4"},"reference-count":36,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"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>Objective: This study aims to evaluate the additional diagnostic value of systematic (SBx) and perilesional biopsies (PBx) compared with targeted biopsy (TBx) in patients with mpMRI-detected PI-RADS 3-4\u20135 lesions. Methods: We performed a retrospective analysis of 208 men with PI-RADS \u2265 3 lesions who underwent mpMRI\u2013ultrasound fusion biopsy at a single institution. Clinically significant prostate cancer (csPCa; ISUP \u2265 2) was identified in 155 patients (74.5%), who constituted the study cohort. All patients underwent a standardized biopsy protocol consisting of 3\u20135 TBx cores, 3 PBx cores sampled within a 10 mm radius of the index lesion, and 10 SBx cores using the KOELIS Trinity\u00ae system. Detection rates of csPCa and ISUP grade upgrading were analyzed and stratified by PI-RADS category. Results: TBx csPCa detection rates increased progressively with PI-RADS score: 39% for PI-RADS 3, 50% for PI-RADS 4, and 60% for PI-RADS 5 lesions. PBx showed a 42.5% detection rate of csPCa in PI-RADS 3 and 58% and 85.3% of csPCa in PI-RADS 4 and 5 respectively, whereas SBx detected 34.5% of csPCa in PI-RADS 3, 46% of csPCa in PI-RADS 4, and 60.5% of csPCa in PI-RADS 5. Despite these detection rates, PBx and SBx rarely provided clinically meaningful upgrading over TBx findings. ISUP grade upgrading occurred in only 7.3% of PBx cases and 1.8% of SBx cases in PI-RADS 5 lesions, with similarly low upgrading rates observed in PI-RADS 3\u20134 lesions. Conclusions: In patients with high-grade lesions like PI-RADS 4\u20135, TBx alone identifies the vast majority of csPCa, while SBx and PBx contribute minimal additional diagnostic or grading benefit. These findings support biopsy de-escalation strategies in high-risk mpMRI settings to reduce unnecessary sampling and procedure-related morbidity. On the other hand, in the PI-RADS 3 subgroup, omitting non-targeted sampling (SBx and\/or PBx) may lead to underdiagnosis of higher-grade tumors not captured by TBx alone, potentially resulting in substantial changes in therapeutic strategy and, consequently, patient prognosis.<\/jats:p>","DOI":"10.3390\/cancers18101593","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:04:09Z","timestamp":1778763849000},"page":"1593","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Limited Incremental Diagnostic Value of Perilesional and Systematic Biopsies in PI-RADS 4\u20135 Lesions: A Retrospective Single-Center Study"],"prefix":"10.3390","volume":"18","author":[{"given":"Emiliano","family":"Scarrone","sequence":"first","affiliation":[{"name":"Department of Urology, ASL AT Cardinal Massaia Hospital, 14100 Asti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vittorio","family":"Canale","sequence":"additional","affiliation":[{"name":"Department of Urology, ASL AT Cardinal Massaia Hospital, 14100 Asti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6067-5497","authenticated-orcid":false,"given":"Luca","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Department of Urology, Villa Pia Clinic Hospital, 00151 Rome, Italy"},{"name":"Department \u2018\u2019Materno Infantile e Scienze Urologiche\u201d, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordi","family":"Stira","sequence":"additional","affiliation":[{"name":"Department of Urology, ASL AT Cardinal Massaia Hospital, 14100 Asti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Gravina","sequence":"additional","affiliation":[{"name":"Department of Urology, ASL AT Cardinal Massaia Hospital, 14100 Asti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Zarrelli","sequence":"additional","affiliation":[{"name":"Department of Urology, ASL AT Cardinal Massaia Hospital, 14100 Asti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7899-8056","authenticated-orcid":false,"given":"Alessandro","family":"Sciarra","sequence":"additional","affiliation":[{"name":"Department \u2018\u2019Materno Infantile e Scienze Urologiche\u201d, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","first-page":"76","article-title":"I numeri del Cancro in Italia nel 2022","volume":"1","author":"Cinieri","year":"2023","journal-title":"AIOM"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Independent UK Panel on Breast Cancer Screening (2012). The benefits and harms of breast cancer screening: An independent review. Lancet, 380, 1778\u20131786.","DOI":"10.1016\/S0140-6736(12)61611-0"},{"key":"ref_3","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_4","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s40291-022-00584-4","article-title":"Proclarix, A New Biomarker for the Diagnosis of Clinically Significant Prostate Cancer: A Systematic Review","volume":"26","author":"Campistol","year":"2022","journal-title":"Mol. Diagn. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.eururo.2017.12.028","article-title":"The Stockholm-3 Model for Prostate Cancer Detection: Algorithm Update, Biomarker Contribution, and Reflex Test Potential","volume":"74","author":"Aly","year":"2018","journal-title":"Eur. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"343","DOI":"10.2214\/AJR.13.11046","article-title":"Accuracy of Multiparametric MRI for Prostate Cancer Detection: A Meta-Analysis","volume":"202","author":"Hamoen","year":"2014","journal-title":"Am. J. Roentgenol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/s10334-022-01006-6","article-title":"The role of MRI in prostate cancer: Current and future directions","volume":"35","author":"Fernandes","year":"2022","journal-title":"Magn. Reson. Mater. Phys. Biol. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1177\/20514158221091402","article-title":"Diagnostic value of the abnormal digital rectal examination in the modern MRI-based prostate cancer diagnostic pathway","volume":"17","author":"Sajjad","year":"2022","journal-title":"J. Clin. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.euo.2021.03.004","article-title":"Using Prostate Imaging-Reporting and Data System (PI-RADS) Scores to Select an Optimal Prostate Biopsy Method: A Secondary Analysis of the Trio Study","volume":"5","author":"Ahdoot","year":"2021","journal-title":"Eur. Urol. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.eururo.2014.10.033","article-title":"Use of the Prostate Imaging Reporting and Data System (PI-RADS) for Prostate Cancer Detection with Multiparametric Magnetic Resonance Imaging: A Diagnostic Meta-analysis","volume":"67","author":"Hamoen","year":"2015","journal-title":"Eur. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1007\/s00330-013-2795-0","article-title":"Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: A prospective study","volume":"23","author":"Bratan","year":"2013","journal-title":"Eur. Radiol."},{"key":"ref_12","first-page":"CD012663","article-title":"Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer","volume":"2019","author":"Drost","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.eururo.2020.12.010","article-title":"Early Detection of Prostate Cancer in 2020 and Beyond: Facts and Recommendations for the European Union and the European Commission","volume":"79","author":"Hogenhout","year":"2021","journal-title":"Eur. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1001\/jamaoncol.2024.0734","article-title":"Magnetic Resonance Imaging in Prostate Cancer Screening: A Systematic Review and Meta-Analysis","volume":"10","author":"Fazekas","year":"2024","journal-title":"JAMA Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1148\/radiol.13122233","article-title":"Prostate cancer localization using multiparametric MR imaging: Comparison of Prostate Imaging Reporting and Data System (PI-RADS) and Likert scales","volume":"269","author":"Rosenkrantz","year":"2013","journal-title":"Radiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/j.eururo.2013.03.030","article-title":"Standards of Reporting for MRI-targeted Biopsy Studies (START) of the Prostate: Recommendations from an International Working Group","volume":"64","author":"Moore","year":"2013","journal-title":"Eur. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Tiger, S., Shpunt, I., Beberashvili, I., Avda, Y., Smolyakov, V., Lerman, D., Goldshtein, G., Shahabri, W., Rubinshtein, D., and Jaber, M. (2025). Influence of Prostate Volume on Targeted Biopsy Outcomes and PI-RADS Predictive Value for Significant Prostate Cancer. J. Clin. Med., 14.","DOI":"10.3390\/jcm14238476"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.eururo.2013.12.062","article-title":"Overdiagnosis and Overtreatment of Prostate Cancer","volume":"65","author":"Loeb","year":"2014","journal-title":"Eur. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1016\/j.eururo.2013.05.049","article-title":"Systematic Review of Complications of Prostate Biopsy","volume":"64","author":"Loeb","year":"2013","journal-title":"Eur. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"208","DOI":"10.5152\/tud.2025.24094","article-title":"Meta Analysis of Efficacy and Safety of Prostate Biopsy: A Comparison Between Transperineal and Transrectal Approach","volume":"50","author":"Warli","year":"2025","journal-title":"Urol. Res. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1038\/s41391-021-00429-x","article-title":"Enhancement of prostate cancer diagnosis by machine learning techniques: An algorithm development and validation study","volume":"25","author":"Chiu","year":"2021","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Tanaka, N., Shimada, K., Nakagawa, Y., Hirao, S., Watanabe, S., Miyake, M., Anai, S., Hirayama, A., Konishi, N., and Fujimoto, K. (2015). The optimal number of initial prostate biopsy cores in daily practice: A prospective study using the Nara Urological Research and Treatment Group nomogram. BMC Res. Notes, 8.","DOI":"10.1186\/s13104-015-1668-9"},{"key":"ref_23","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-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent","volume":"86","author":"Cornford","year":"2024","journal-title":"Eur. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/j.eururo.2018.11.040","article-title":"The FUTURE Trial: A Multicenter Randomised Controlled Trial on Target Biopsy Techniques Based on Magnetic Resonance Imaging in the Diagnosis of Prostate Cancer in Patients with Prior Negative Biopsies","volume":"75","author":"Wegelin","year":"2019","journal-title":"Eur. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.juro.2012.08.095","article-title":"Targeted Biopsy in the Detection of Prostate Cancer Using an Office Based Magnetic Resonance Ultrasound Fusion Device","volume":"189","author":"Sonn","year":"2013","journal-title":"J. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1007\/s11255-025-04875-7","article-title":"Impact of a new diagnostic pathway for prostate cancer\u2014From systematic transrectal to targeted MRI fusion transperineal biopsies","volume":"58","author":"Kristensen","year":"2025","journal-title":"Int. Urol. Nephrol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1111\/iju.14295","article-title":"Value of extra-target prostate biopsy for the detection of magnetic resonance imaging-missed adverse pathology according to the Prostate Imaging Reporting and Data System scores: Spatial analysis using magnetic resonance\u2013ultrasound fusion images","volume":"27","author":"Matsuoka","year":"2020","journal-title":"Int. J. Urol."},{"key":"ref_28","unstructured":"Gharib, M.H., Tirtashi, R.H., Tamaskani, N., Salamat, F., Ghazimoghaddam, B., Niakan, B., and Nematollahi, N. (2024). Insights on detecting clinically significant prostate cancer in PI- RADS v2.1 scores of 4 and 5. Med. Res. Arch., 12."},{"key":"ref_29","first-page":"e97745","article-title":"Association of Prostate Imaging Reporting and Data System (PI-RADS) Score and Prostate-Specific Antigen Density (PSAD) With Prostate Biopsy Histology Outcomes: A Retrospective Study","volume":"17","author":"Balasubaramaniam","year":"2025","journal-title":"Cureus"},{"key":"ref_30","first-page":"23","article-title":"Positive Predictive Value of High-Grade Prostate Imaging and Reporting Data System V2.1 Magnetic Resonance Imaging Findings for Prostate Cancer","volume":"34","author":"Mehammed","year":"2024","journal-title":"Ethiop. J. Health Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"110852","DOI":"10.1016\/j.ejrad.2023.110852","article-title":"MRI-informed prostate biopsy: What the radiologist should know on quality in biopsy planning and biopsy acquisition","volume":"164","author":"Girometti","year":"2023","journal-title":"Eur. J. Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"7068","DOI":"10.1007\/s00330-024-10795-4","article-title":"PI-QUAL version 2: An update of a standardised scoring system for the assessment of image quality of prostate MRI","volume":"34","author":"Allen","year":"2024","journal-title":"Eur. Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Franz, T., Sicker, T., Lueke, J., Dinh, B., Ho, T.P., Spinos, T., Horn, L.-C., Schaudinn, A., Liatsikos, E., and Stolzenburg, J.-U. (2025). To biopsy or not biopsy, that is the question\u2014PI-RADS 3 prostate lesions\u2014Validation of clinical and radiological parameters for biopsy decision-making. BMC Urol., 25.","DOI":"10.1186\/s12894-025-01986-2"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"20210413","DOI":"10.1259\/bjr.20210413","article-title":"Optimal biopsy approach for detection of clinically significant prostate cancer","volume":"95","author":"Ippoliti","year":"2022","journal-title":"Br. J. Radiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.29271\/jcpsp.2024.10.1205","article-title":"Unlocking Precision Enhancing Prostate Cancer Detection and Reducing Unnecessary Biopsies with Combined Prostate-Specific Antigen Density and PI-RADS Score","volume":"34","author":"Hamidi","year":"2024","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1038\/s41391-021-00441-1","article-title":"Artificial intelligence for target prostate biopsy outcomes prediction the potential application of fuzzy logic","volume":"25","author":"Checcucci","year":"2021","journal-title":"Prostate Cancer Prostatic Dis."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/10\/1593\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:16:17Z","timestamp":1778764577000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/10\/1593"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":36,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["cancers18101593"],"URL":"https:\/\/doi.org\/10.3390\/cancers18101593","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]}}}