Ipsilateral systematic biopsy with targeted biopsy suffices for PI-RADS 4-5 lesions, reducing overdiagnosis

Targeted plus ipsilateral systematic biopsy detected 97.3% of clinically significant prostate cancers in men with PI-RADS 4-5 lesions, matching full systematic biopsy but with less overdiagnosis (retrospective).

• Retrospective review of 300 men with unilateral PI-RADS 4 or 5 lesion undergoing MRI-ultrasound fusion biopsy.
• Sensitivity for clinically significant cancer: TB alone 85.7% vs. TB+iSB 97.3% (p<0.001); TB+SB not significantly better.
• Overdiagnosis of insignificant cancer increased from 49.3% (TB+iSB) to 62.7% (TB+SB); 75 contralateral cores needed for one additional significant cancer at cost of 7.5 insignificant cancers.

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