The Prostate - ORIGINAL ARTICLE - Is Saturation Biopsy Still a Viable Alternative to Fusion Biopsy in the Era of Multiparametric MRI? A Comparative Analysis in Patients With Prior Negative Biopsy

Q: What was the study comparing in men with prior negative biopsies?

The study compared TRUS-guided saturation biopsy (SB) with mpMRI-TRUS fusion-guided combined biopsy (CB). Outcomes included prostate cancer and clinically significant prostate cancer detection rates.

Q: How did CB and SB perform overall for detecting prostate cancer and csPCa?

Overall prostate cancer detection rates were similar (20% for CB vs 16.3% for SB, p=0.682). csPCa detection rates were also comparable (11.3% for CB vs 7.5% for SB, p=0.589).

Q: Why does the paper suggest SB may still be useful without mpMRI?

CB had a higher csPCa yield, particularly when PI-RADS ≥4 lesions were present, but mpMRI availability is limited in some settings. The authors conclude SB remains a viable, safe, and effective alternative when mpMRI is unavailable or contraindicated.

Sep 23, 2026

Uploaded by Rizky

A retrospective comparative analysis evaluates transrectal ultrasound (TRUS)-guided saturation biopsy (SB) versus multiparametric MRI (mpMRI)-TRUS fusion–guided combined biopsy (CB) for men with prior negative prostate biopsies. Data from 160 patients assess prostate cancer (PCa) and clinically significant PCa (csPCa) detection rates alongside clinical parameters. CB shows the highest csPCa diagnostic yield, especially with PI-RADS ≥4 lesions, while SB remains a viable, safe option where mpMRI access is limited. PSA derivatives may help refine biopsy decisions.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Introduction

Prostate cancer diagnosis and limitations of standard biopsy

Rationale for mpMRI-targeted and combined biopsy

Study objective in resource-limited settings

Materials and Methods

Study design and ethical approval

The Prostate ORIGINAL ARTICLE Is Saturation Biopsy Still a Viable Alternative to Fusion Biopsy in the Era of Multiparametric MRI? A Comparative Analysis in Patients With Prior Negative Biopsy Arda Taşkın Taşkıran1 | Yusuf Şenoğlu2 1Department of Urology, Faculty of Medicine, Duzce University, Duzce, Turkey | 2Department of Urology, Faculty of Medicine, Marmara University, Istanbul, Turkey Correspondence: Arda Taşkın Taşkıran ([drardataskiran@gmail.com](drardataskiran@gmail.com)) Received: 24 January 2026 | Revised: 14 March 2026 | Accepted: 19 March 2026 Keywords: MRI‐US fusion biopsy | prostate cancer | repeat biopsy | saturation biopsy ABSTRACT Background: We aimed to compare the diagnostic accuracy of transrectal ultrasound (TRUS)‐guided saturation biopsy (SB) and multiparametric MRI (mpMRI)‐TRUS fusion‐guided combined biopsy (CB) in patients with prior negative prostate biopsies. Methods: We retrospectively analyzed data from 160 patients who underwent transrectal prostate biopsy between January 2014 and March 2021. All had at least one prior negative biopsy. 80 patients underwent SB with a 20‐core TRUS‐guided approach. The remaining 80 patients, with mpMRI‐detected PIRADS ≥ 3 lesions, underwent CB including 12‐core systematic plus 2–4 targeted cores per lesion. Prostate cancer and clinically significant prostate cancer (csPCa) detection rates, and clinical parameters were compared between groups. Results: The groups had no statistically significant differences in baseline characteristics. The PCa detection rate was 20% in the CB group and 16.3% in the SB group (p = 0.682) . csPCa detection rates were also similar: 11.3% in the CB cohort and 7.5% in the SB cohort (p = 0.589) . Notably, the CB subgroup with PI‐RADS ≥ 4 lesions had a significantly higher csPCa detection rate (28.6%) than SB group (7.5%) (p = 0.016). Patients diagnosed with PCa had significantly lower free PSA and free/total PSA ratios (p < 0.05) . Complication rates were low and similar in both groups. Conclusions: CB demonstrates the highest diagnostic yield for detecting csPCa, particularly in patients with PI‐RADS ≥ 4 lesions. However, in resource‐limited settings lacking mpMRI, systematic saturation biopsy remains a viable, safe, and effective alternative. PSA derivatives may serve as complementary tools to refine biopsy decisions. 1 | Introduction Prostate cancer (PCa) is the second most diagnosed malignancy among men worldwide [1]. According to the European Association of Urology (EAU) guidelines, the standard method for diagnosing PCa is transrectal ultrasound (TRUS) or transperineal‐guided biopsy utilizing 10–12 core samples [2]. However, standard biopsy protocols sample less than 0.05% of the prostate tissue on average. Furthermore, over 30% of cancers are located in the anterior horns, the apex, or the transitional zone—areas frequently missed by standard TRUS‐guided techniques [3, 4]. Consequently, the standard 12‐core TRUS biopsy is associated with a false‐negative rate of up to 20%[5]. In patients with persistently elevated serum prostate‐specific antigen (PSA) levels despite an initial negative biopsy, This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2026 The Author(s) . The Prostate published by Wiley Periodicals LLC. The Prostate, 2026; 86:990–996 990 [https://doi.org/10.1002/pros.70169](https://doi.org/10.1002/pros.70169) saturation biopsy (SB)—which involves obtaining more than 20 cores in a systematic manner—has traditionally been proposed to improve diagnostic yield [6–8] . However, increasing the number of cores may lead to greater procedural discomfort, higher rates of temporary erectile dysfunction, and the overdiagnosis of indolent, low‐risk cancers, potentially complicating treatment d

FAQs

What was the study comparing in men with prior negative biopsies?

The study compared TRUS-guided saturation biopsy (SB) with mpMRI-TRUS fusion-guided combined biopsy (CB). Outcomes included prostate cancer and clinically significant prostate cancer detection rates.

How did CB and SB perform overall for detecting prostate cancer and csPCa?

Overall prostate cancer detection rates were similar (20% for CB vs 16.3% for SB, p=0.682). csPCa detection rates were also comparable (11.3% for CB vs 7.5% for SB, p=0.589).

Why does the paper suggest SB may still be useful without mpMRI?

CB had a higher csPCa yield, particularly when PI-RADS ≥4 lesions were present, but mpMRI availability is limited in some settings. The authors conclude SB remains a viable, safe, and effective alternative when mpMRI is unavailable or contraindicated.

Sep 23, 2026

Uploaded by Rizky