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Yield of concurrent systemic biopsy during MRI-targeted biopsy according to Prostate Imaging Reporting and Data System version 2 in patients with suspected prostate cancer



To investigate the yield of concurrent systemic biopsy (SB) during MRI-targeted biopsy (MRTB) as Prostate Imaging Reporting and Data System (PI-RADS) version 2 (v2) interpretations in patients with suspected prostate cancer (PCa).


A total of 285 patients with suspected PCa underwent prebiopsy 3-T MRI, followed by MRI-transrectal ultrasound fusion targeted biopsy and concurrent standard SB for lesions with PI-RADS v2 scores 3–5. Detection rates and positive core rates of PCa and clinically significant cancer (CSC) were evaluated.


In concurrent MRTB and SB, PCa and CSC detection rates were 18.9% and 9.4% for PI-RADS score 3, 45.9% and 32.4% for PI-RADS score 4, and 82.1% and 72.6% for PI-RADS score 5, respectively. Overall detection rate of CSCs (40.0%) for concurrent MRTB and SB was significantly higher than that of MRTB (34.4%, p = 0.004) or SB alone (27.7%, p < 0.001): an increase of 5.6% (16 patients) compared with MRTB alone. For patients with PI-RADS score 4 or 5, the CSC detection rate of concurrent MRTB and SB was 47.0%, an increase of 6.1% when compared with MRTB (40.9%) only (p < 0.001). Of the 110 patients with both MRTB- and SB-positive findings, 22 (20.0%) had the highest Gleason score in SB compared with that in MRTB. In 9.5% (27/285) patients including 12 patients with CSCs, only SB was positive, with negative MRTB.


Concurrent SB with MRTB based on PI-RADS v2 can yield a higher CSC detection rate compared with MRTB alone in patients with suspected PCa.

Key Points

• Concurrent SB with MRTB yields an increase of 5.6% CSC detection compared with MRTB alone.

• Of both MRTB- and SB-positive findings, 20.0% patients have upgraded Gleason score in SB.

• In 18.4% patients, only SB was positive, with negative MRTB. Adding MRTB to SB is helpful for adequate risk stratification, reducing diagnostic uncertainty of PCa.

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Fig. 1
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Fig. 3



Clinically significant cancer


Gleason score


Multiparametric magnetic resonance imaging


MRI-targeted biopsy


Prostate cancer


Prostate Imaging Reporting and Data System


Prostate-specific antigen


Peripheral zone


Systemic biopsy


Transrectal ultrasound


Transition zone


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This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1A2B4006020).

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Corresponding author

Correspondence to Chan Kyo Kim.

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The scientific guarantor of this publication is Chan Kyo Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Insuk Sohn, PhD, kindly provided statistical advice for this manuscript.

Informed consent

This retrospective study was approved by our institutional review board, with a waiver of the requirement for informed consent.

Ethical approval

Institutional Review Board approval was obtained. Approval from the institutional animal care committee was not required because this study was on human subjects.


• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Kim, C.H., Kim, C.K., Park, J.J. et al. Yield of concurrent systemic biopsy during MRI-targeted biopsy according to Prostate Imaging Reporting and Data System version 2 in patients with suspected prostate cancer. Eur Radiol 31, 1667–1675 (2021).

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  • Prostate cancer
  • Magnetic resonance imaging
  • Biopsy
  • Image-guided biopsy