Background/Objectives: It remains unclear whether certain areas of the prostate are more difficult to accurately sample using MRI/US-fusion-guided freehand single-access transperineal prostate biopsy (FSA-TP). The aim of this study was to evaluate the detection rates of clinically significant (cs) and clinically insignificant (ci) prostate cancer (PCa) in each prostate zone during FSA-TP MRI-target biopsies (MRI-TBs) and systematic biopsies (SB).Methods: This monocentric observational study included a cohort of 277 patients with no prior history of PCa who underwent 3 MRI-TB cores and 14 SB cores with an FSA-TP from January to December 2023. The intraclass correlation coefficient (ICC) was assessed to evaluate the correlation between the Prostate Imaging–Reporting and Data System (PI-RADS) of the index lesion and the International Society of Urological Pathology (ISUP) grade stratified according to prostate zone and region of index lesion at MRI. Multivariate logistic regression analysis was conducted to identify factors associated with PCa and csPCa in patients with discordant results between MRI-TB and SB.Results: FSA-TP-MRI-TB demonstrated higher detection rates of both ciPCa and csPCa in the anterior, apical, and intermediate zones when each of the three MRI-TB cores was analysed separately (p< 0.01). However, when all MRI-TB cores were combined, no significant differences were observed in detection rates across prostate zones (apex, mid, base;p= 0.57) or regions (anterior vs. posterior;p= 0.34). Concordance between radiologic and histopathologic findings, as measured by the intraclass correlation coefficient (ICC), was similar across all zones (apex ICC: 0.33; mid ICC: 0.34; base ICC: 0.38) and regions (anterior ICC: 0.42; posterior ICC: 0.26). Univariate analysis showed that in patients with PCa detected on SB but with negative MRI-TB, older age was the only significant predictor (p= 0.04). Multivariate analysis revealed that patients with PCa detected on MRI-TB but with negative SB, only PSA remained a significant predictor (OR 1.2, 95% CI 1.1–1.4;p= 0.01). In cases with csPCa detected on MRI-TB but with negative SB, age (OR: 1.0, 95% CI 1.0–1.1;p= 0.02), positive digital rectal examination (OR: 2.0, 95% CI 1.1–3.8;p= 0.03), PI-RADS score >3 (OR: 4.5, 95% CI 1.7–12.1;p< 0.01), and larger lesion size (OR: 1.1, 95% CI 1.1–1.2;p< 0.01) were significant predictors.Conclusions: FSA-TP using 14 SB cores and 3 MRI-TB cores ensures comprehensive sampling of all prostate regions, including anterior and apical zones, without significant differences in detection rates between nodules across different zones. Only in a small percentage of patients was csPCa detected exclusively by SB, highlighting the small but important complementary value of combining SB and MRI-TB.
背景/目的：目前尚不清楚在使用MRI/US融合引导自由手单通道经会阴前列腺活检（FSA-TP）时，前列腺的某些区域是否更难准确取样。本研究旨在评估FSA-TP MRI靶向活检（MRI-TB）和系统活检（SB）在前列腺各分区中对临床有意义（cs）和临床无意义（ci）前列腺癌（PCa）的检出率。 方法：这项单中心观察性研究纳入了277名无PCa病史的患者队列，他们在2023年1月至12月期间接受了FSA-TP，包括3针MRI-TB和14针SB。通过计算组内相关系数（ICC）来评估前列腺影像报告和数据系统（PI-RADS）评分与国际泌尿病理学会（ISUP）分级之间的相关性，并根据MRI所示前列腺分区及靶病灶区域进行分层。对MRI-TB与SB结果不一致的患者，采用多变量逻辑回归分析来确定与PCa和csPCa相关的因素。 结果：当分别分析三针MRI-TB中的每一针时，FSA-TP-MRI-TB在前列腺前部、尖部和中间区对ciPCa和csPCa均显示出更高的检出率（p<0.01）。然而，当合并所有MRI-TB针时，前列腺各分区（尖部、中部、底部；p=0.57）或区域（前部 vs. 后部；p=0.34）之间的检出率未观察到显著差异。通过ICC测量的影像学与组织病理学结果的一致性在所有分区（尖部ICC：0.33；中部ICC：0.34；底部ICC：0.38）和区域（前部ICC：0.42；后部ICC：0.26）中均相似。单变量分析显示，在SB检出PCa但MRI-TB阴性的患者中，年龄较大是唯一的显著预测因素（p=0.04）。多变量分析显示，在MRI-TB检出PCa但SB阴性的患者中，仅PSA是显著预测因素（OR 1.2，95% CI 1.1–1.4；p=0.01）。在MRI-TB检出csPCa但SB阴性的病例中，年龄（OR：1.0，95% CI 1.0–1.1；p=0.02）、直肠指检阳性（OR：2.0，95% CI 1.1–3.8；p=0.03）、PI-RADS评分>3（OR：4.5，95% CI 1.7–12.1；p<0.01）以及更大的病灶体积（OR：1.1，95% CI 1.1–1.2；p<0.01）是显著的预测因素。 结论：采用14针SB和3针MRI-TB的FSA-TP方案确保了对所有前列腺区域（包括前部和尖部）的全面取样，且不同分区结节间的检出率无显著差异。仅在少数患者中，csPCa仅由SB检出，这凸显了联合SB与MRI-TB虽小但重要的互补价值。
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