Int Urol Nephrol. 2026 Jan 24. doi: 10.1007/s11255-026-05029-z. Online ahead of print.
ABSTRACT
PURPOSE: To evaluate whether systematic contralateral biopsy can be safely omitted in men with MRI-detected prostate lesions (PI-RADS ≥ 3) and to assess the impact of contralateral findings on treatment decisions.
MATERIALS AND METHODS: A retrospective cohort of 617 patients with pre-biopsy multiparametric MRI showing at least one PI-RADS ≥ 3 lesion underwent cognitive MRI-targeted biopsy of the index lesion, perilesional sampling (≥ 6 cores), and contralateral systematic biopsy (≥ 6 cores). Primary endpoint was upgrading in the contralateral lobe versus index/perilesional regions. Secondary endpoint was the impact of contralateral biopsy omission on treatment decision. Statistical analyses included Friedman’s test, Wilcoxon signed-rank, one-way ANOVA with Games-Howell, and McNemar’s test.
RESULTS: Median age was 69 years, median PSA 7.83 ng/mL, and median prostate volume 46 cc. Positive cores were observed in 76.3%, 83.3%, and 51.9% of index, perilesional, and contralateral biopsies, respectively. Contralateral lobe ISUP grade was significantly lower than the maximum index/perilesional grade (median 1 vs 2, p < 0.001). Clinically significant prostate cancer (ISUP ≥ 2) was present in 81% of index/perilesional regions versus 39% of contralateral. Only 2.1% of patients had clinically significant cancer isolated to the contralateral lobe (number needed to test = 48). Contralateral findings altered management in 6.3% of cases, predominantly in patients with low-risk features.
CONCLUSIONS: Tumor burden is predominantly localized to the index and perilesional regions. Contralateral biopsy minimally contributes to detecting high-grade disease or modifying treatment decisions. A selective MRI-directed approach combining targeted and perilesional sampling with judicious contralateral biopsy may optimize diagnostic yield while reducing procedural burden.
PMID:41579321 | DOI:10.1007/s11255-026-05029-z
