PURPOSE Enhanced histological detection of clinically significant prostate cancer is the goal of the prebiopsy imaging pathway. Risk stratification at a prebiopsy meeting can facilitate optimization of lesion targeting. We aimed to evaluate the feasibility of cognitive registration, freehand transperineal prostate biopsy in a biopsy-naïve population following biparametric MRI for the detection of clinically significant disease (International Society of Urological Pathology Grade Group ≥2). MATERIALS AND METHODS A consecutive series of biopsy-naïve men, prospectively recorded between July 2018 and March 2023, were risk-stratified at our prebiopsy meeting following biparametric MRI to undergo either target-only biopsy or target with systematic biopsy. Biopsies were routinely performed under local anesthesia and without antibiotic prophylaxis in the outpatient setting. Overall prostate cancer and clinically significant prostate cancer detection were primary outcomes. RESULTS Of 1251 biopsies, prostate cancer was detected in 84% and clinically significant disease in 70.6%. Prostate cancer and clinically significant disease were detected in 86.2% and 76.5% of target-only biopsies, respectively, and in 78.7% and 56.3% of target with systematic biopsies. Postbiopsy complication rate was 0.7%. CONCLUSIONS Prebiopsy biparametric MRI with risk stratification at a prebiopsy meeting in the setting of cognitive targeting and freehand transperineal prostate biopsy yielded a high detection of prostate cancer that is comparable to other studies. These data support the use of cognitive registration, freehand transperineal prostate biopsy as safe, feasible, and cost-effective.

中文翻译：

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在未接受过活检的男性中使用认知登记和徒手经会阴前列腺活检对双参数磁共振成像靶向病变的诊断途径结果（CRAFT 单中心研究）。


目的 增强对具有临床意义的前列腺癌的组织学检测是活检前成像途径的目标。在活检前会议上进行风险分层有助于优化病灶靶向。我们旨在评估认知登记、徒手经会阴前列腺活检在双参数 MRI 后未进行活检的人群中检测有临床意义的疾病的可行性 （国际泌尿病理学会分级组 ≥2）。材料和方法 2018 年 7 月至 2023 年 3 月期间前瞻性记录的连续系列未接受过活检的男性，在我们的活检前会议上，在双参数 MRI 后进行风险分层，接受仅目标活检或目标系统活检。活检在局部麻醉下常规进行，门诊不进行抗生素预防。总体前列腺癌和有临床意义的前列腺癌检测是主要结局。结果 在 1251 例活检中，84% 检测到前列腺癌，70.6% 检测到有临床意义的疾病。在 86.2% 和 76.5% 的仅靶区活检中检测到前列腺癌和有临床意义的疾病，在 78.7% 和 56.3% 的系统性活检靶区中检测到前列腺癌和有临床意义的疾病。活检后并发症发生率为 0.7%。结论 在认知靶向和徒手经会阴前列腺活检的背景下，活检前双参数 MRI 和风险分层对前列腺癌的检出率很高。这些数据支持使用认知登记、徒手经会阴前列腺活检是安全、可行且具有成本效益的。