Targeted-only biopsy misses 6.5% of significant prostate cancers in PI-RADS 3 lesions

In 902 men with PI-RADS 3 MRI lesions, a targeted-only biopsy strategy missed 6.5% (95% CI 5.0-8.4) of clinically significant prostate cancers found by combined targeted and systematic sampling. The omission cost fell to just 0.8% in men with PSA density <0.10 ng/mL/cm3 undergoi…

• A combined biopsy strategy detected clinically significant prostate cancer (grade group ≥2) in 27% (240/902) of men, compared to 20% (181/902) by targeted biopsy alone; 59 cancers were missed by omitting systematic cores.
• When a stricter definition of clinically significant disease (grade group ≥3) was used, the absolute omission cost decreased to 2.8% (25/902).
• Each additional targeted core independently reduced the odds of a targeted biopsy false-negative result (adjusted odds ratio 0.69, 95% CI 0.54–0.86).

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