Ricerc@Sapienza

Traditionally, diagnosis of PCa relied on extended transrectal US (TRUS)-guided systematic sampling of the prostate. This approach, however, frequently misses or underestimates the disease burden given the inability of ultrasound to distinguish between PCa and benign prostatic tissue. Recently, the quick adoption of targeted biopsies (TBx) has led to an increase in the detection rate of clinically significant PCa (csPCa) compared with TRUS-guided biopsy alone. Moreover, TBx has been shown to better predict RP final pathologic features compared with systematic biopsies. Different approaches are available for targeting lesions identified at prebiopsy multiparametric magnetic resonance imaging (MRI), including: (a) cognitive registration, which uses information on the location of the suspicious areas with the goal of sampling that region; (b) software-assisted fusion; and (c) direct, MRI-guided, in-bore biopsy. While some studies have suggested that MRI In-Bore biopsies are superior to MRI TRUS fusion biopsies in the detection of clinically significant PCa, it remains unknown whether the precision inherent to this spatially selective technique increases the likelihood of non-indolent PCa overestimation resulting in a downgrade to indolent PCa detection. Conversely, because systematic sampling is not performed during In-Bore biopsies, MRI-invisible lesions that may be detected with fusion plus systematic biopsies could be missed with the in-bore paradigm. Thus, while targeted biopsies improve the prediction of final radical prostatectomy pathologic features compared with systematic sampling alone, it is unknown whether different targeting techniques have different PCa vs. csPCa detection rates and moreover, no information is available regarding the overall percentage of malignant tissue sampled accoridng to the preferred techinique.