Optimal prostate biopsy strategies for PI-RADS 3-5 lesions identified in network meta-analysis

Saturation or ipsilateral systematic plus targeted biopsy match standard combined biopsy for clinically significant prostate cancer detection in PI-RADS 3-5, with fewer biopsies. Targeted biopsy alone insufficient; systematic biopsy still needed for PI-RADS 5.

• Saturation targeted biopsy and ipsilateral systematic biopsy + targeted biopsy had comparable clinically significant cancer detection to combined systematic and targeted biopsy for PI-RADS 3–5 lesions.
• Targeted biopsy alone is not adequate, and omitting systematic biopsy in PI-RADS 5 lesions is not supported by current evidence.
• Tailored strategies may reduce overdiagnosis but require further validation in larger cohorts with standardized protocols.

Automated summary

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