Sextant Systematic Biopsy Versus Extended 12-Core Systematic Biopsy in Combined Biopsy for Prostate Cancer

Background: This study assessed the comparative effectiveness of sextant and extended 12core systematic biopsy within combined biopsy for the detection of prostate cancer. Methods: Patients who underwent combined biopsy targeting lesions with a Prostate Imaging Reporting and Data System (PI-RADS) score of 3-5 were assessed. Two specialists performed all combined cognitive biopsies. Both specialists performed target biopsies with five or more cores. One performed sextant systematic biopsies, and the other performed extended 12 -core systematic biopsies. A total of 550 patients were analyzed. Results: Cases requiring systematic biopsy in combined biopsy exhibited a significant association with age >= 65 years (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.25- 4.32; P = 0.008), PI-RADS score (OR, 2.32; 95% CI, 1.25-4.32; P = 0.008), and the number of systematic biopsy cores (OR, 3.69; 95% CI, 2.11-6.44; P < 0.001). In patients with an index lesion of PI-RADS 4, an extended 12 -core systematic biopsy was required (target -negative/ systematic -positive or a greater Gleason score in the systematic biopsy than in the targeted biopsy) (P < 0.001). Conclusion: During combined biopsy for prostate cancer in patients with PI-RADS 3 or 5, sextant systematic biopsy should be recommended over extended 12 -core systematic biopsy when an effective targeted biopsy is performed.