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Combined TBx+SBx provides improved detection rates particularly for higher-grade disease over either systematic or MRI-targeted biopsy or TRUS-Bx alone. However, superiority in significant cancer detection did not reflect accurate Gleason Grade Group in whole prostate gland at final surgical pathology due to selective sampling of higher grade areas within an otherwise low grade cancer. There is a risk of overtreatment if biopsy GGG was taken as the sole parameter for treatment decision by TBx+SBx. Conventional TRUS-Bx has superior concordance with radical prostatectomy for ISUP Grade 2,3,5 however increased upgrading should be taken into account.
Key words: Prostate cancer, targeted biopsy, MRI/US Fusion, prostate biopsy, concordance, upgrading, downgrading