Abstract
We investigated the change to definitive treatment in patients under active surveillance (AS) and cancer diagnosis in non-cancerous patients for prostate cancer after confirmatory transperineal template-guided mapping prostate biopsy (TTMB). We retrospectively reviewed 336 patients who underwent TTMB between March 2017 and March 2023, with 134 AS patients and 202 non-cancerous patients. All patients were routinely followed up via prostate-specific antigen (PSA) and multiparametric magnetic resonance imaging (mpMRI), and follow-up biopsy was performed when deemed clinically appropriate. Treatment changes in the AS and cancer detection in non-cancerous groups were analyzed. One hundred and thirty-four patients under the AS protocol were analyzed, of which 110 (82.1%) maintained AS for 33 months. Nine patients (6.7%) had significant findings in mpMRI (prostate imaging–reporting and data system [PI-RADS] ≥3) and received radical treatment following target biopsy via transrectal ultrasonography. Totally, 115 patients (83.3%) with insignificant findings in mpMRI (PI-RADS 1 or 2 lesions) were followed up with transrectal ultrasound-guided prostate biopsy (17.4%, N = 20), repeat TTMB (6.1%, N = 7), or no additional biopsy (76.5%, N = 88), and five (25.0%), two (28.5%), and eight (9.1%) patients converted to radical treatment from each group, respectively. In the non-cancerous group, five patients (2.5%) were diagnosed with prostate cancer, with PI-RADS ≥3 findings via mpMRI and were confirmed by target biopsy, during a mean follow-up period of 25 months, subsequently receiving radical treatment. TTMB is effective in selecting patients for AS treatment, confirming benign patients, and can be used as an effective follow-up modality.