Value of systematic biopsy added to target biopsy for detecting significant cancer in men with Prostate Imaging and Reporting and Data System 5

Purpose: To assess the value of systematic biopsy added to target biopsy for detecting significant cancer in men with Prostate Imaging and Reporting and Data System 5 (PI-RADS 5). Methods: Between March 2014 and November 2018, 186 men had a PI-RADS 5 categorized as an index lesion on magnetic resonance imaging prior to transrectal ultrasound (TRUS)-guided biopsy. Of these patients, 135 (group I) underwent target biopsy alone because of good depiction. The remaining 51 (group II) underwent target and systematic biopsies because of poor depiction. Significant cancer detection rates (CDRs) were compared between the groups. Which type of biopsies contributed to detecting significant cancer was evaluated in the group II. Results: Significant CDRs of the target biopsy were 67.4% (91/135) in the group I and 47.1% (24/51) in the group II (P=0.0173). However, when systematic biopsy was added to target biopsy, the significant CDR of the group II increased to 52.9% (27/51) (P=0.0900). Of the 27 significant cancers missed by target biopsy in the group II, three were detected by systematic biopsy alone. Moreover, systematic biopsy detected higher Gleason scores in two cases than target biopsy. Conclusion: Systematic biopsy contributes to detecting additional significant cancers in men with PI-RADS 5 partially visible on TRUS.