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Systematic biopsy of the prostate can be omitted in men with PIRADS 5 and PSA density greater than 15%

  • Alessandro Tafuri,
  • Atsuko Iwata,
  • Aliasger Shakir,
  • Tsuyoshi Iwata,
  • Chhavi Gupta,
  • Akash Sali,
  • Dordaneh Sugano,
  • Abtahi Seyed Mahdi,
  • Giovanni E Cacciamani,
  • Masatomo Kaneko,
  • Jie Cai,
  • Osamu Ukimura,
  • Vinay Duddalwar,
  • Manju Aron,
  • Inderbir S Gill,
  • Suzanne L Palmer,
  • Andre Luis Abreu

Publication: Journal of Urology, April 2021


To evaluate the prostate cancer (PCa) and clinically significant PCa (CSPCa) detection on systematic (SB), target biopsy (TB) alone and combined SB and TB in men with Prostate Imaging Reporting and Data System (PIRADS)-5 lesion.

Material and Methods

From a prospectively maintained prostate biopsy (PBx) database, we identified consecutive patients with PIRADS 5 lesion on multiparametric magnetic resonance imaging (mpMRI). The patients underwent mpMRI followed by transrectal TB of PIRADS 5 lesion and 12-core SB. The PCa and CSPCa (Grade Group, GG ≥2) detection on SB, TB and SB+TB were determined for all men and accordingly to PSA density (PSAD). Statically significant if p <0.05.


Overall, 112 patients met inclusion criteria. The detection rate of PCa for SB, TB and SB+TB was 89%, 93% and 95%; for CSPCa it was 72%, 81% and 85%, respectively. SB added 2% PCa and 4% CSPCa detection to TB. A total of 78 patients had PSAD>0.15ng/mL2, and the detection rate of PCa for SB, TB and SB+TB was 92%, 97% and 97%; and for CSPCa it was 79%, 91% and 95%, respectively. In this population, if SB was omitted, zero PCa and only 4% (n=3) of CSPCa would be missed. The CSPCa detection rate improved with increased PSAD for SB (p=0.01), TB (p <0.0001) and combined SB+TB (p=0.002).


In patients with PIRADS 5 on mpMRI and PSAD >0.15ng/mL2, SB marginally increases CSPCa detection, but not overall PCa detection in comparison to TB alone. Systematic biopsy did not affect patients’ management and can be omitted on this population.