The MRI targeted biopsy (MRI-TBx) may increase the detection rate of clinically significant cancer (csPCa) in candidates for re-biopsy. However, there will be several patients in whom MRI is contraindicated. In this retrospective study we assessed the ability of combination of PDS guided biopsies (PDS-TBx) and modified SBx to substitute MRI-TBx. 154 men with persistently elevated PSA were referred for re-biopsy. Our protocol included a combination of MRI-TBx, DPS-TBx and modified SBx with additional biopsies from anterior lateral horns and anterior aspects of apex. MRI findings were defined as suspicious lesions (MRI-SL) and highly suspicious lesions (MRI-HL), based on PIRADS scale. In 40 patients csPCa was detected. While, MRI diagnosed csPCa in 36 patients (23%, n-36/154): 25% and 92% of biopsies targeted to the MRI- SL and MRI-HSL confirmed csPCa. Thirty-eight PDS hypervascular areas were found, while csPCa was diagnosed in 84% of these lesions, or in 28 patients (18%, n-28/154). SBx detected csPCa in 34 cores or in 21 patients (13%, n – 21/154). SBx missed cancers in the in the anterior aspect of middle gland. Combination of PDS-TBx + SBx detected csPCa in 35 (88% of csPCa) patients. Strongest predictors for the csPCa presence were MRI-HSL, PDS’ lesions and biopsies from anterior aspect that included apex, mid gland and anterior lateral horns (p < 0.001 and p-0.008, respectively). The combination of PDS-TBx + SBx may miss 15% of csPCa detected by MRI. However, it can detect additional 10% of csPCa that were missed by MRI. To improve the accuracy of this combination, the anterior aspect of middle gland should be also included in the modified SBx. These changes in combination can make it helpful in candidates for re-biopsy who cannot undergo MRI.

MRI靶向活检（MRI-TBx）可以提高重新活检候选者中临床上显着癌症（csPCa）的检测率。但是，将有几位患者禁忌MRI。在这项回顾性研究中，我们评估了PDS引导活检（PDS-TBx）和改良的SBx替代MRI-TBx的能力。154名PSA持续升高的男性被转诊接受再次活检。我们的方案包括MRI-TBx，DPS-TBx和改良的SBx的组合，以及来自前侧角和前尖的额外活检。根据PIRADS量表，MRI表现被定义为可疑病变（MRI-SL）和高度可疑病变（MRI-HL）。在40例患者中检测到csPCa。而MRI在36例患者中诊断出csPCa（23％，n-36 / 154）：靶向MRI-SL和MRI-HSL的活检样本中有25％和92％证实了csPCa。发现了38个PDS高血管区域，而在这些病变中84％或28例患者中诊断出csPCa（18％，n-28 / 154）。SBx在34个核心或21位患者中检测到csPCa（13％，n – 21/154）。SBx在中部腺的前部漏诊了癌症。PDS-TBx + SBx的组合在35例（占csPCa的88％）患者中检测到了csPCa。对于csPCa存在的最强预测指标是MRI-HSL，PDS病变和从前侧开始的活检，包括顶点，中腺和前侧角（PDS-TBx + SBx的组合在35例（占csPCa的88％）患者中检测到了csPCa。对于csPCa存在的最强预测指标是MRI-HSL，PDS病变和从前侧开始的活检，包括顶点，中腺和前侧角（PDS-TBx + SBx的组合在35例（占csPCa的88％）患者中检测到了csPCa。对于csPCa存在的最强预测指标是MRI-HSL，PDS病变和从前侧开始的活检，包括顶点，中部腺体和前侧角（p  <0.001和p-0.008）。PDS-TBx + SBx的组合可能会错过MRI检测到的csPCa的15％。但是，它可以检测出MRI遗漏的另外10％的csPCa。为了提高这种组合的准确性，改良的SBx中还应包括中部腺体的前部。这些改变的组合可以帮助无法进行MRI复活的候选人。