It may be possible to spare sampling of the transitional zone during combined targeted and systematic prostate biopsies when multiparametric magnetic resonance imaging (mpMRI) is negative in that zone, according to investigators.

A total of 863 men had peripheral lesions suspicious for prostate cancer and a negative transitional zone on mpMRI. They underwent combined prostate biopsy involving peripheral targeted biopsy and systematic biopsy with or without transitional-zone sampling. 

The extended and standard biopsy protocol yielded similar rates of detection of Gleason score 3+4 or higher cancers (48% vs 47%) and Gleason score 3+3 cancers (21% vs 20%), respectively, Mykyta Kachanov, MD, of Prostate Cancer Center Hamburg-Eppendorf in Hamburg, Germany, and colleagues reported in The Journal of Urology. Transitional-zone sampling during systematic biopsy detected only 2.0% additional clinically significant prostate cancers. They noted that transitional zone cancers are less prevalent than peripheral zone cancers and tend to be lower grade.

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In logistic regression analyses, how lesions were distributed across prostate zones on mpMRI and their PI-RADS scores predicted whether transitional-zone sampling would yield clinically significant prostate cancer.

Furthermore, sparing the transitional zone avoided a median 3 cores per patient. Obtaining more biopsy cores correlates with higher rates of complications, according to the investigators. Transitional-zone sampling often results in hematuria, pain, and voiding deterioration. This study lacked data on complications preventing further analysis.

“These findings of our zone-dependent biopsy strategy warrant prospective evaluation to modify and optimize the extent of systematic biopsies in presence of mpMRI suspicious [prostate cancer] lesions,” Dr Kachanov’s team concluded.


Kachanov M, Leyh-Bannurah SR, Roberts MJ, et al. Optimizing combined MRI targeted and systematic biopsy strategies: Sparing the mpMRI-negative transitional-zone in presence of exclusively peripheral mpMRI-suspect lesions. J Urol. Published online September 24, 2021.doi:10.1097/JU.0000000000002248