Introduction: Routine systematic prostate biopsy still is recommended beside targeted biopsies, since without it, a significant proportion of prostate cancer (PCa) will be missed. Out of the various methods, we investigated two in a head-to-head comparison: the volumetric-optimized software-supported (VOT) and the conventional cognitive freehand (CFT) ultrasound-guided systematic prostate biopsy. Methods: This is a retrospective analysis within a consecutive cohort of men undergoing prostate biopsy between 2014 and 2023. Baseline characteristics, diagnostic performance in detecting PCa with corresponding relative risks, have been assessed. Results: A total of 573 patients have been included into analysis: 135 in the CFT and 438 in the VOT group. In the CFT group, 25 (18.5%) showed positive with significant PCa (defined as Gleason Score ≥7), and in the VOT group 125 (28.5%), respectively. The relative risk for the diagnosis of significant cancer was statistically significantly higher in the VOT compared to the CFT group with a relative risk of 1.54 (95% CI from 1.05 to 2.26), whereas the relative risk for insignificant cancer was almost identical. Conclusion: Our results showed that VOT has better diagnostic performance than CFT in detecting significant PCa (defined as Gleason Score ≥7). Taking the study limitations into consideration, the corroboration of our results in other cohorts would promote their generalizability.

Journal Section:
Research Article
Keywords:
Systematic prostate biopsy, Methods
1.
van der Leest
M
,
Cornel
E
,
Israel
B
,
Hendriks
R
,
Padhani
AR
,
Hoogenboom
M
, et al.
Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naive men with elevated prostate-specific antigen: a large prospective multicenter clinical study
.
Eur Urol
.
2019
;
75
(
4
):
570
–
8
.
Google Scholar
 
2.
Kasivisvanathan
V
,
Rannikko
AS
,
Borghi
M
,
Panebianco
V
,
Mynderse
LA
,
Vaarala
MH
, et al.
MRI-Targeted or standard biopsy for prostate-cancer diagnosis
.
N Engl J Med
.
2018
;
378
(
19
):
1767
–
77
.
Google Scholar
 
3.
Rouvière
O
,
Puech
P
,
Renard-Penna
R
,
Claudon
M
,
Roy
C
,
Mège-Lechevallier
F
, et al.
Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study
.
Lancet Oncol
.
2019
;
20
(
1
):
100
–
9
.
Google Scholar
 
4.
von Elm
E
,
Altman
DG
,
Egger
M
,
Pocock
SJ
,
Gøtzsche
PC
,
Vandenbroucke
JP
;
STROBE Initiative
.
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
.
BMJ
.
2007
;
335
(
7624
):
806
–
8
.
Google Scholar
 
5.
Austin
PC
.
Balance diagnostics for comparing the distribution of baselinecovariates between treatment groups in propensity-scorematched samples
.
Stat Med
.
2009
;
28
(
25
):
3083
–
107
.
Google Scholar
 
6.
R Core Team
.
R: A language and environment for statistical computing
.
Vienna, Austria
:
R Foundation for Statistical Computing
;
2024
. Available from: https://www.R-project.org/
7.
Kasivisvanathan
V
,
Stabile
A
,
Neves
JB
,
Giganti
F
,
Valerio
M
,
Shanmugabavan
Y
, et al.
Magnetic resonance imaging-targeted biopsy versus systematic biopsy in the detection of prostate cancer: a systematic review and meta-analysis
.
Eur Urol
.
2019
;
76
(
3
):
284
–
303
.
Google Scholar
 
8.
Drost
FJH
,
Osses
D
,
Nieboer
D
,
Bangma
CH
,
Steyerberg
EW
,
Roobol
MJ
, et al.
Prostate magnetic resonance imaging, with or without magnetic resonance imaging-targeted biopsy, and systematic biopsy for detecting prostate cancer: a cochrane systematic review and meta-analysis
.
Eur Urol
.
2020
;
77
(
1
):
78
–
94
.
Google Scholar
 
9.
Deniffel
D
,
Perlis
N
,
Ghai
S
,
Girgis
S
,
Healy
GM
,
Fleshner
N
, et al.
Prostate biopsy in the era of MRI-targeting: towards a judicious use of additional systematic biopsy
.
Eur Radiol
.
2022
;
32
(
11
):
7544
–
54
.
Google Scholar
 
10.
Yamada
Y
,
Ukimura
O
,
Kaneko
M
,
Matsugasumi
T
,
Fujihara
A
,
Vourganti
S
, et al.
Moving away from systematic biopsies: image-guided prostate biopsy (in-bore biopsy, cognitive fusion biopsy, MRUS fusion biopsy) -literature review
.
World J Urol
.
2021
;
39
(
3
):
677
–
86
.
Google Scholar
 
11.
Jahnen
M
,
Amiel
T
,
Wagner
T
,
Kirchhoff
F
,
Büchler
JW
,
Düwel
C
, et al.
Does experience change the role of systematic biopsy during MRI-fusion biopsy of the prostate
.
World J Urol
.
2023
;
41
(
10
):
2699
–
705
.
Google Scholar
 
12.
Cornford
P
,
van den Bergh
RCN
,
Briers
E
,
Van den Broeck
T
,
Brunckhorst
O
,
Darraugh
J
, et al.
EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on prostate Cancer: 2024 update. Part I – screening, diagnosis, and local treatment with curative intent
.
Eur Urol
.
2024
;
86
(
2
):
148
–
63
.
Google Scholar
 
13.
Greer
MD
,
Shih
JH
,
Lay
N
,
Barrett
T
,
Bittencourt
L
,
Borofsky
S
, et al.
Interreader variability of prostate imaging reporting and data system version 2 in detecting and assessing prostate cancer lesions at prostate MRI
.
AJR Am J Roentgenol
.
2019
;
212
(
6
):
1197
–
205
.
Google Scholar
 
14.
Shukla-Dave
A
,
Hricak
H
.
Role of MRI in prostate cancer detection
.
NMR Biomed
.
2014
;
27
(
1
):
16
–
24
.
Google Scholar
 
15.
Girometti
R
,
Giannarini
G
,
Peruzzi
V
,
Amparore
D
,
Pizzolitto
S
,
Zuiani
C
.
MRI-informed prostate biopsy: what the radiologist should know on quality in biopsy planning and biopsy acquisition
.
Eur J Radiol
.
2023
;
164
:
110852
.
Google Scholar
 
16.
Trecarten
S
,
Sunnapwar
AG
,
Clarke
GD
,
Liss
MA
.
Prostate MRI for the detection of clinically significant prostate cancer: update and future directions
.
Adv Cancer Res
.
2024
;
161
:
71
–
118
.
Google Scholar
 
© 2025 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2025
You do not currently have access to this content.