[New Prostate Cancer Guideline: Is Biopsy of PI-RADS 3 Lesions Meaningful? The Role of Multiparametric MRI-Ultrasound Fusion Biopsy in Detecting Clinically Significant Prostate Cancer].

This study evaluated 476 patients who underwent both systematic 12-core and multiparametric MRI-guided fusion biopsies to detect clinically significant prostate cancer (Gleason score ≥3+4=7a).

Multiparametric MRI fusion biopsy, guided by PI-RADS score, was a strong predictor of relevant carcinoma (p<0.001).

Key findings include:

• Combining systematic and MRI-guided biopsies reduced the number needed to test (NNT) to 2.4, compared to 3.6 for systematic biopsy alone.
• The NNT varied by PI-RADS score:
  • 13.7 for PI-RADS 3
  • 3.8 for PI-RADS 4
  • 1.7 for PI-RADS 5
• Consistent biopsy of PI-RADS 4 and 5 lesions is supported.
• PI-RADS 3 lesions warrant individualized assessment to avoid overdiagnosis.

These results reinforce current guideline recommendations advocating risk-adapted diagnostic strategies in prostate cancer.