Targeted transperineal biopsy of the prostate has limited additional benefit over background cores for larger MRI-identified tumors

Purpose To compare histological outcomes in patients undergoing MRI–transrectal ultrasound fusion transperineal (MTTP) prostate biopsy and determine the incremental benefit of targeted cores. Methods Seventy-six consecutive patients with 89 MRI-identified targets underwent MTTP biopsy. Separate targeted biopsies and background cores were obtained according to a standardized protocol. Target biopsies were considered of added diagnostic value if these cores showed a higher Gleason grade than non-targeted cores taken from the same sector (Group 1, n = 41). Conversely, where background cores demonstrated an equal or higher Gleason grade, target cores were considered to be non-beneficial (Group 2, n = 48). Results There was no significant difference in age, PSA, prostate volume, time-to-biopsy, and number of cores obtained between the groups. A greater proportion of target cores were positive for cancer (158/228; 69.3 %) compared to background (344/1881; 18.38 %). The median target volume was 0.54 cm 3 for Group 1 (range 0.09–2.79 cm 3 ) and 1.65 cm 3 for Group 2 (0.3–9.07 cm 3 ), p 1.0 cm.