Comparing 12-core and 20-core biopsy for prostate cancer diagnosis with transperineal MR/US fusion biopsy - assessing the effective number of systemic cores using propensity score matching

Sep 24, 2026

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Transperineal (TP) prostate biopsy with MRI-visible target sampling lacks consensus on the number of systemic biopsy cores. This retrospective study analyzed 494 treatment-naive TP biopsy patients, comparing 12-core (n=293) versus 20-core (n=201) systemic strategies. Propensity score matching minimized confounding when evaluating clinically significant prostate cancer, defined by PIRADS score thresholding and index-positive/negative status. After matching, detection did not improve overall with 20 cores, but higher odds emerged when MRI showed no suspicious lesion.

LanguageEnglish

CategoryHealthcare

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International Urology and Nephrology (2023) 55:2465–2471 [https://doi.org/10.1007/s1](https://doi.org/10.1007/s1) 1255-023-03674-2 Comparing 12‑core and 20‑core biopsy for prostate cancer diagnosis with transperineal MR/US fusion biopsy: assessing the effective number of systemic cores using propensity score matching Hyeok Jae Kwon1 · Seung Ah Rhew1 · Chang Eil Yoon1 · Dongho Shin1 · Seokhwan Bang1 · Yong Hyun Park1 · Hyuk Jin Cho1 · U‑Syn Ha1 · Sung‑Hoo Hong1 · Ji Youl Lee1 · Sae Woong Kim1 · Hyong Woo Moon1 Received: 10 May 2023 / Accepted: 12 June 2023 / Published online: 20 June 2023 © The Author(s) 2023 Abstract Purpose For transperineal (TP) prostate biopsy, target biopsy for visible lesions on MRI is important, but there is no consensus of the number of systemic biopsy cores. Our study aimed to confirm the diagnostic efficiency of 20-core systemic biopsy by comparison with 12-core using propensity score matching (PSM) . Methods The 494 patients conducted the naive TP biopsy were retrospectively analyzed. There were 293 patients with 12-core biopsy and 201 patients with 20-core biopsy. PSM was performed for minimizing confounding variables, and the established effects’ value was analyzed for ‘index-positive or negative’ clinically significant prostate cancer (csPCa) (Index means PIRADS Score ≥ 3 on multiparametric prostate MRI) . Results At 12-core biopsy, there were 126 cases of prostate cancer (43.0%), and 97 cases of csPCa (33.1%) . At 20-core biopsy, there were 91 cases (45.3%) and 63 cases (31.3%) . After propensity score matching, for index-negative csPCa, the estimated odds ratio was 4.03 (95% CI 1.35–12.09, p value 0.0128), and for index-positive csPCa, the estimated odds ratio was 0.98 (95% CI 0.63–1.52, p value 0.9308) . Conclusions The 20-core biopsy did not show a higher detection rate for csPCa in comparison with the 12-core biopsy. However, when MRI did not show a suspicious lesion, 20-core biopsy showed higher odd ratio in comparison with 12-core biopsy. Therefore, if there is a suspicious lesion in MRI, 20-core biopsy is excessive and 12-core biopsy is sufficient. Whereas if there is no suspicious lesion in MRI, it is better to proceed with 20-core biopsy. Keywords Prostate cancer · Propensity score · Image-guided biopsy · Magnetic resonance imaging Introduction Worldwide, prostate cancer is the third most common cancer, with an estimated 1,414,259 new cases and 375,304 deaths reported in 2020 [1].In South Korea, prostate cancer is rapidly increasing and ranks as the fourth most common cancer among males, with estimated 16,749 new cases and 2140 deaths reported in 2021 [2]. For the histological diagnosis of prostate cancer, transrectal ultrasonography (TRUS) biopsy using a 12-core biopsy template was considered the * Hyong Woo Moon [aspasias@hanmail.net](aspasias@hanmail.net) 1 Department of Urology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea standard procedure in the past [3] . However TRUS biopsy showed a high false-negative rate (one study showed that it was up to 30%[4]) and several complications were observed. Some of the complications were severe enough to require patient hospitalization [5] . In particular, infection through the rectum by TRUS biopsy can induce sepsis, so European Association of Urology (EAU) and American Urology Association (AUA) recommend transperineal biopsy if possible [6] . Multiparametric magnetic resonance imaging (MRI) can provide novel functional parameters for non-invasive risk assessment before biopsy [7], so it becomes a very important tool for prostate cancer’s initial diagnosis [8, 9] . Therefore, transperineal biopsy using multiparametric MRI is recommended for prostate cancer biopsy recently, because of the low false-negative rate and decreased unnecessary biopsy [10]. And, it also showed improved sensitivity for detecting intermediate

FAQs

What is the main goal of the study?

To compare diagnostic efficiency of 20-core versus 12-core systemic biopsy in TP prostate cancer diagnosis, using propensity score matching, and to assess differences by MRI index-positive/negative status.

How were patients grouped and analyzed?

The study retrospectively included 494 treatment-naive TP biopsy patients, with 293 undergoing 12-core biopsy and 201 undergoing 20-core biopsy. Propensity score matching was used to reduce confounding variables before evaluating outcomes.

What did the results show after propensity score matching?

Overall, the 20-core approach did not demonstrate a higher detection rate for clinically significant prostate cancer compared with 12 cores. However, when MRI did not show a suspicious lesion (index-negative csPCa), the odds ratio favored 20 cores.

What practical recommendation is suggested by the conclusions?

If MRI shows a suspicious lesion, 20-core biopsy is considered excessive and 12-core biopsy is sufficient; if MRI shows no suspicious lesion, proceeding with 20-core biopsy is suggested.

Sep 24, 2026

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