A Multicentre Study of the Clinical Utility of Non-targeted Systematic Transperineal Prostate Biopsies in Patients Undergoing Pre-biopsy mpMRI.

PURPOSE The added value of non-targeted systematic prostate biopsies (NT-PBx), when performed alongside MRI-targeted biopsies (T-PBx), in men referred with a suspicion of prostate cancer is unclear. We aimed to determine the clinical utility of transperineal NT-Bx, when performed alongside T-Bx, using pre-biopsy multiparametric magnetic resonance imaging (mpMRI). MATERIALS AND METHODS Consecutive patients referred with a suspicion of prostate cancer (April/2017-October/2019) underwent a pre-biopsy mpMRI. A transperineal biopsy was advised if mpMRI PI-RADS (v.2.0) score was 4 or 5; score 3 required a PSA-density >/=0.12ng/ml. Primary threshold for clinically significant prostate cancer (csPCa) was defined as any Gleason >/=3+4. Multivariable logistic regression analysis identified pre-biopsy predictors of csPCa in NT-PBx, irrespective of targeted-pathology (p 4+3 was detected. Predictors associated with csPCa in NT-PBx were: PSA >/=5ng/ml (OR 2.05; [95%CI 1.13-3.73]; p=0.02), PI-RADS score=5 (OR 2.26; 95%CI 1.51-3.38; p<0.001]) and prostate volume <50cc (OR 2.47, [95%CI 1.57-3.87]; p<0.001). CONCLUSIONS Detection of csPCa in exclusively non-targeted transperineal systematic biopsies in a pre-biopsy mpMRI pathway was low (1.9%).