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A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies Picola Brau, Natalia Paesano, Nahuel Ruiz Plazas, Xavier Muñoz-Rivero, Marta V. Muñoz-Rodriguez, Jesus Celma, Ana Morote Robles, Juan Institut Català de la Salut [Morote J, Celma A] Servei d’Urologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Departament de Cirurgia, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Picola N] Servei d’Urologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain. [Muñoz-Rodriguez J] Servei d’Urologia, Hospital Universitari Parc Taulí, Sabadell, Spain. [Paesano N] Clínica Creu Blanca, Barcelona, Spain. [Ruiz-Plazas X] Servei d’Urologia, Hospital Universitari Joan XXIII, Tarragona, Spain. [Muñoz-Rivero MV] Servei d’Urologia, Hospital Arnau de Vilanova, Lleida, Spain Vall d'Hebron Barcelona Hospital Campus Pròstata - Càncer - Diagnòstic Biòpsia ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Clinical Laboratory Techniques::Cytological Techniques::Cytodiagnosis::Biopsy DISEASES::Neoplasms::Neoplasms by Site::Urogenital Neoplasms::Genital Neoplasms, Male::Prostatic Neoplasms Other subheadings::Other subheadings::/diagnosis TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::técnicas de laboratorio clínico::técnicas citológicas::citodiagnóstico::biopsia ENFERMEDADES::neoplasias::neoplasias por localización::neoplasias urogenitales::neoplasias de los genitales masculinos::neoplasias de la próstata Otros calificadores::Otros calificadores::/diagnóstico Prostate biopsy concordance; Systematic biopsy; Targeted biopsy Concordancia de biopsia de próstata; Biopsia sistemática; Biopsia dirigida Concordança de biòpsia de pròstata; Biòpsia sistemàtica; Biòpsia dirigida The primary objective of this study was to analyse the current accuracy of targeted and systematic prostate biopsies in detecting csPCa. A secondary objective was to determine whether there are factors predicting the finding of csPCa in targeted biopsies and, if so, to explore the utility of a predictive model for csPCa detection only in targeted biopsies. We analysed 2122 men with suspected PCa, serum PSA > 3 ng/mL, and/or a suspicious digital rectal examination (DRE), who underwent targeted and systematic biopsies between 2021 and 2022. CsPCa (grade group 2 or higher) was detected in 1026 men (48.4%). Discrepancies in csPCa detection in targeted and systematic biopsies were observed in 49.6%, with 13.9% of csPCa cases being detected only in systematic biopsies and 35.7% only in targeted biopsies. A predictive model for csPCa detection only in targeted biopsies was developed from the independent predictors age (years), prostate volume (mL), PI-RADS score (3 to 5), mpMRI Tesla (1.5 vs. 3.0), TRUS-MRI fusion image technique (cognitive vs. software), and prostate biopsy route (transrectal vs. transperineal). The csPCa discrimination ability of targeted biopsies showed an AUC of 0.741 (95% CI 0.721–0.762). The avoidance rate of systematic prostate biopsies went from 0.5% without missing csPCa to 18.3% missing 4.6% of csPCa cases. We conclude that the csPCa diagnostic accuracy of targeted biopsies is higher than that of systematic biopsies. However, a significant rate of csPCa remains detected only in systematic biopsies. A predictive model for the partial omission of systematic biopsies was developed. This research was funded by the Instituto de Salut Carlos III (SP) and the European Union, grant number PI20/01666. 2023-10-05T07:47:08Z 2023-10-05T07:47:08Z 2023-09-13 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Morote J, Picola N, Muñoz-Rodriguez J, Paesano N, Ruiz-Plazas X, Muñoz-Rivero M V, et al. A Diagnostic Accuracy Study of Targeted and Systematic Biopsies to Detect Clinically Significant Prostate Cancer, including a Model for the Partial Omission of Systematic Biopsies. Cancers (Basel). 2023 Sep 13;15(18):4543. 2072-6694 https://hdl.handle.net/11351/10408 10.3390/cancers15184543 37760511 http://hdl.handle.net/11351/10408 eng Cancers;15(18) https://doi.org/10.3390/cancers15184543 info:eu-repo/grantAgreement/ES/PEICTI2021-2023%2FPI20%2F01666 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf MDPI Scientia