Abstract
OBJECTIVE: Systematic biopsy (SBx) underdetects clinically significant prostate cancer and overdiagnoses indolent disease. This study compared the transperineal cognitive fusion targeted biopsy (COG-TBx)-which uses multiparametric MRI for precision-against SBx, evaluating their cancer detection rates and safety profiles in a clinical cohort. METHODS: A total of 360 patients undergoing transperineal prostate biopsy were included, with 161 assigned to the COG-TBx group and 199 to the SBx group. Primary outcomes included PCa detection, csPCa (defined as Gleason score ≥ 3 + 4 or ISUP Level ≥ 2), and 30-day complication rates. Secondary outcomes comprised cancer detection rate per core and pathological characteristics. Statistical analyses involved χ² tests, t-tests, and multivariable logistic regression. RESULTS: Baseline characteristics were comparable between groups, though prostate volume was larger in the COG-TBx group (52.0 ml vs. 46.0 ml, P = 0.024). The COG-TBx group demonstrated significantly higher PCa (52.2% vs. 41.2%, P = 0.034) and csPCa detection rates (44.7% vs. 25.6%, P < 0.05), as well as a higher cancer detection rate per needle (28.5% vs. 19.3%, P = 0.003). The overall 30-day complication rate was slightly higher in the COG-TBx group (13.0% vs. 7.0%, P > 0.05), without statistical significance. Multivariate analysis identified COG-TBx (OR = 1.98, 95% CI: 1.15-3.41, P = 0.013) and PSA level (OR = 1.12 per ng/mL, 95% CI: 1.03-1.22, P = 0.008) as independent predictors of csPCa detection. CONCLUSION: Transperineal COG-TBx is associated with higher detection rates for prostate cancer and clinically significant cancer compared to SBx. Although associated with a slightly higher complication rate, the difference was not significant. The overall benefit supports the clinical adoption of COG-TBx.