Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Can fewer transperineal systematic biopsy cores have the same prostate cancer detection rate as of magnetic resonance imaging/ultrasound fusion biopsy?




Due to the discomfort and incidence of complications increases with the increasing number of biopsy cores, the protocol of prostate biopsy has been promoted from systematic biopsy (SB) to targeted biopsy (TB) in many studies. However, the optimal prostate sampling scheme to balance the incidence of biopsy complications and accuracy of biopsy remains controversial. Our objective is to explore an optimal prostate cancer (PCa) sampling scheme with fewer SB cores.


Patients with at least one lesion of Prostate Imaging Reporting and Data System ≥3 were prospectively enrolled. TB and SB were performed for each patient as reference. The hypothetical biopsy sampling schemes were TB only, SB only, and TB followed by SB of the nontargeted sector (TB+nSB). The PCa and clinically significant PCa (csPCa) detection rates and cores of the three hypothetical biopsy schemes were compared with TB+SB.


Among 165 patients, 107 (64.8%) were diagnosed with PCa and 91 (55.2%) with csPCa via TB+SB. There were 54 (50.5%) and 42 (46.2%) magnetic resonance imaging (MRI) true negative cases and 53 (49.5%) and 49 (53.8%) false negative cases of nontargeted sectors among PCa and csPCa patients, respectively. The maximal cancer proportion in positive biopsy cases differed significantly between the true and false groups of these cohorts. There was no difference between TB+nSB and TB+SB for PCa or csPCa detection.


The optimal sampling scheme TB+nSB with fewer SB cores showed same PCa and csPCa detection rates as that of standard TB+SB with MRI/ultrasound fusion biopsy.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1: The targeted and nontargeted sectors of prostate(Illustrated by Yuanyuan Li).


  1. 1.

    Surveillance, E., and End Results Program, Cancer Stat Facts: Prostate Cancer. Nation Cancer Institute,, 2020.

  2. 2.

    Mohler JL, S. S, and A. ES, NCCN clinical practice guidelines in oncology: prostate cancer (Version 4.2019). J Natl Compr Cancer Netw., 2019-08-19.

  3. 3.

    Mottet N, v.d. BR, Biers E et al. EAU Guideline Prostate Cancer, 2019. Accessed March 2019.

  4. 4.

    Schoots Ivo G, Roobol Monique J, Nieboer Daan, Bangma Chris H, Steyerberg Ewout W, Hunink M G Myriam. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol., 2015, 68:438–50.

  5. 5.

    Marco Borghesi, Hashim Ahmed, Robert Nam, Edward Schaeffer, Riccardo Schiavina, Samir Taneja, et al. Complications after systematic, random, and image-guided prostate biopsy. Eur. Urol. 2017;71:353–65.

    Article  Google Scholar 

  6. 6.

    Stabile Armando, Giganti Francesco, Rosenkrantz AndrewB, Taneja SamirS, Villeirs Geert, Gill InderbirS, et al. Multiparametric MRI for prostate cancer diagnosis: current status and future directions. Nat Rev Urol. 2020;17:41–61.

    PubMed  Article  Google Scholar 

  7. 7.

    Yuval Freifeld, Yin Xi, Niccolo Passoni, Solomon Woldu, Brad Hornberger, Kenneth Goldberg, et al. Optimal sampling scheme in men with abnormal multiparametric MRI undergoing MRI-TRUS fusion prostate biopsy. Urol Oncol. 2019;37:57–62.

    Article  Google Scholar 

  8. 8.

    Epstein JIWP, Carmichael M, Brendler CB. Pathologic and clinical findings to predict tumor extent of nonpalpable (Stage T1 c) prostate cancer. JAMA. 1994;271:368–74.

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Gawlitza JR-ZM, Thörmer G, Schaudinn A, Linder N, Garnov N, Horn LC, et al. Impact of the use of an endorectal coil for 3 T prostate MRI on image quality and cancer detection rate. Sci Rep. 2017;7:40640.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  10. 10.

    Weinreb Jeffrey C, Barentsz Jelle O, Choyke Peter L, Cornud Francois, Haider MasoomA, Macura KatarzynaJ, et al. PI-RADS prostate imaging – reporting and data system: 2015, Version 2. Eur Urol. 2016;69:16–40.

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Ahdoot Michael, Wilbur AndrewR, Reese SarahE, Lebastchi AmirH, Mehralivand Sherif, Gomella PatrickT, et al. MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. N Engl J Med. 2020;382:917–28.

    PubMed  PubMed Central  Article  Google Scholar 

  12. 12.

    Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. PROMIS study group. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389:815–22.

    PubMed  Article  Google Scholar 

  13. 13.

    Kasivisvanathan Veeru, Rannikko AnttiS, Borghi Marcelo, Panebianco Valeria, Mynderse LanceA, Vaarala MarkkuH, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. 2018;378:1767–77.

    PubMed  Article  Google Scholar 

  14. 14.

    Pokorny MR, Thompson LC. Is magnetic resonance imaging-targeted biopsy now the standard of care? Eur Urol. 2019;76:304–5.

    PubMed  Article  Google Scholar 

  15. 15.

    Wong MCGW, Wang HH, Fung FD, Leung C, Wong SY, et al. Global incidence and mortality for prostate cancer: analysis of temporal patterns and trends in 36 countries. Eur Urol. 2016;70:862–74.

    PubMed  Article  Google Scholar 

  16. 16.

    Chang AJAK, Roach M III, Scher HI. High-risk prostate cancer-classification and therapy. Nat Rev Clin Oncol. 2014;11:308–23.

    PubMed  PubMed Central  Article  Google Scholar 

  17. 17.

    Serrano NA, Anscher MS. Favorable vs unfavorable intermediate-risk prostate cancer: a review of the new classification system and its impact on treatment recommendations. Oncology (Williston Park). 2016;30:229–36.

    PubMed  Google Scholar 

  18. 18.

    Bryk DarrenJ, Llukani Elton, Taneja SamirS, Rosenkrantz AndrewB, Huang WilliamC, Lepor Herbert. The role of ipsilateral and contralateral transrectal ultrasound-guided systematic prostate biopsy in men with unilateral magnetic resonance imaging lesion undergoing magnetic resonance imaging-ultrasound fusion-targeted prostate biopsy. Urology. 2017;102:178–82.

    PubMed  Article  Google Scholar 

  19. 19.

    Wei-Wei Shen, Li-Gang Cui, Wei-Qiang Ran, Yan Sun, Jie Jiang, Xin-Long Pei, et al. Targeted biopsy with reduced number of cores: optimal sampling scheme in patients undergoing magnetic resonance imaging/transrectal ultrasound fusion prostate biopsy. Ultrasound Med Biol. 2020;46:1197–207.

    Article  Google Scholar 

  20. 20.

    Aminsharifi Alireza, Gupta RajanT, Tsivian Efrat, Sekar Sitharthan, Sze Christina, Polascik ThomasJ. Reduced Core Targeted (RCT) biopsy: combining multiparametric magnetic resonance imaging – transrectal ultrasound fusion targeted biopsy with laterally-directed sextant biopsies – An alternative template for prostate fusion biopsy. Eur J Radiol. 2019;110:7–13.

    PubMed  Article  Google Scholar 

  21. 21.

    Glaser Alexander P, Novakovic Kristian, Helfand Brian T. The impact of prostate biopsy on urinary symptoms, erectile function, and anxiety. Curr Urol Rep. 2012;13:447–54.

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Baojun Wang, Jie Gao, Qing Zhang, Chengwei Zhang, Guangxiang Liu, Wang Wei, et al. Investigating the equivalent performance of biparametric compared to multiparametric MRI in detection of clinically significant prostate cancer. Abdom Radiol. 2020;45:547–55.

    Article  Google Scholar 

  23. 23.

    Francesco Porpiglia, Matteo Manfredi, Fabrizio Mele, Marco Cossu, Enrico Bollito, Andrea Veltri, et al. Diagnostic pathway with multiparametric magnetic resonance imaging versus standard pathway: results from a randomized prospective study in biopsy-naïve patients with suspected prostate cancer. Eur Urol. 2017;72:282–88.

    Article  Google Scholar 

  24. 24.

    Heijmink SWFJ, Hambrock T, Takahashi S, Scheenen TW, Huisman HJ, et al. Prostate cancer: body-array versus endorectal coil MR imaging at 3 T-comparison of image quality, localization, and staging performance. Radiology. 2007;244:184–95.

    PubMed  Article  Google Scholar 

  25. 25.

    Hamoen EstherHJ, de Rooij Maarten, Witjes JAlfred, Barentsz Jelle O, Rovers MaroeskaM. Use of the prostate imaging reporting and data system (PI-RADS) for prostate cancer detection with multiparametric magnetic resonance imaging: a diagnostic meta-analysis. Eur Urol. 2015;67:1112–21.

    PubMed  Article  Google Scholar 

  26. 26.

    Hambrock Thomas, Somford DiederikM, Huisman HenkjanJ, van Oort Inge M, Witjes JAlfred, Hulsbergen-van de Kaa ChristinaA, et al. Relationship between apparent diffusion coefficients at 3.0-T MR imaging and Gleason grade in peripheral zone prostate cancer. Radiology. 2011;259:453–61.

    PubMed  Article  Google Scholar 

Download references


HL and MJR contributed equally to this work. We thank the entire staff of the Department of Urology, Peking University First Hospital.

Author contributions

HL and MJR contributed equally to this work. GS conceived and designed the study. HL, MJR, Hao Wang, and GS collected the data. He Wang analyzed mpMRI results. HL, MJR, and XYL analyzed and interpreted the data. HL drafted the manuscript. GS revised the manuscript. All authors read and approved the final manuscript.


This study was supported by Joint Fund of Peking University (BMU2020MI003).

Author information



Corresponding author

Correspondence to Gang Song.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Liu, H., Ruan, M., Wang, H. et al. Can fewer transperineal systematic biopsy cores have the same prostate cancer detection rate as of magnetic resonance imaging/ultrasound fusion biopsy?. Prostate Cancer Prostatic Dis 23, 589–595 (2020).

Download citation


Quick links