Omitting Contralateral Systematic Biopsy in Solitary PI-RADS Lesions Misses Only 2.6% of Significant Prostate Cancers

In 1506 men with PI-RADS 3-5 lesions, skipping all systematic biopsy would have missed 25% of Grade Group ≥2 cancers. However, for men with a solitary lesion, omitting contralateral systematic biopsies missed only 2.6% of such cancers, potentially reducing overdiagnosis of Grade…

• Rates of clinically significant cancer increased with PI-RADS (3:19%, 4:48%, 5:66%) and PSA density (<0.1:25%, ≥0.2:62%).
• No subgroup based on PI-RADS and PSA density could safely avoid systematic biopsy with <5% missed cancers.
• This is a retrospective single-institution study; generalizability may vary.

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