Introduction: Concurrent systematic biopsies during image-guided targeted biopsies of the prostate were found to improve the detection rate of clinically significant prostate cancer (CSPC). However, these biopsies do not routinely include anterior or apical sampling. We aimed to evaluate the significance of anterior and apical samplings during combined biopsies.

Methods: After obtaining institutional review board approval we identified 303 consecutive patients who underwent transperineal combined biopsies of the prostate between 2017-2020. Systematic biopsies were obtained from the peripheral zone, anterior zone, and apex. Study outcomes included CSPC and any cancer on anterior or apical biopsies. Logistic regression analyses were used to evaluate the association between pre-biopsy characteristics and study outcomes.

Results: Median prostatic-specific-antigen value was 6.8 ng/dL. Most patients had stage T1c disease (77%). Overall, combined biopsies detected CSPC in 87 patients (29%). Any cancer and CSPC in the anterior zone were found in 54 (18%) and 19 (6%) patients, respectively. Any cancer and CSPC in the apex were found in 54 (18%) and 16 (5%) patients, respectively. Anterior/apical samplings upgraded the pathological result in 19 patients (6%). Logistic regression analyses demonstrated that PI-RADS 5 lesions predicted the presence of CSPC in both the anterior zone (OR = 8, 95%CI = 3-22, P <0.001) and apex (OR = 4, 95%CI = 1-10, P = 0.01).

Conclusions: Avoiding anterior and apical samplings during prostate biopsy does not result in substantial under-diagnosis of significant cancer. However, these areas are easily accessible using the transperineal approach and should be sampled in selected patients, particularly those with PI-RADS 5 lesions.

简介：发现在图像引导的前列腺靶向活检过程中同时进行系统活检可以提高临床显着前列腺癌 (CSPC) 的检出率。然而，这些活检通常不包括前部或根尖取样。我们旨在评估联合活检期间前部和根尖取样的重要性。

方法：在获得机构审查委员会的批准后，我们​​确定了 303 名在 2017 年至 2020 年间连续接受经会阴联合前列腺活检的患者。从外周区、前区和顶点获得系统活检。研究结果包括 CSPC 和前部或根尖活检的任何癌症。逻辑回归分析用于评估活检前特征与研究结果之间的关联。

结果：中位前列腺特异性抗原值为 6.8 ng/dL。大多数患者患有 T1c 期疾病（77%）。总体而言，联合活检在 87 名患者 (29%) 中检测到 CSPC。分别在 54 名 (18%) 和 19 名 (6%) 患者中发现了前区的任何癌症和 CSPC。分别在 54 名 (18%) 和 16 名 (5%) 患者中发现了心尖部的任何癌症和 CSPC。前部/根尖取样提高了 19 名患者 (6%) 的病理结果。Logistic 回归分析表明，PI-RADS 5 病灶预测 CSPC 在前区（OR = 8, 95%CI = 3-22, P <0.001）和心尖（OR = 4, 95%CI = 1- 10，P  = 0.01）。

结论：在前列腺活检期间避免前部和顶端取样不会导致严重癌症的严重漏诊。然而，这些区域使用经会阴方法很容易到达，应该在选定的患者中取样，特别是那些有 PI-RADS 5 病变的患者。