Prospective per‐target analysis of the added value of the PrecisionPoint Transperineal Access System in cognitive prostate biopsy of MRI targets

Abstract Objectives The objective of this study is to evaluate the diagnostic performance of perineal access cannulas tethered to a biplanar ultrasound probe in cognitive transperineal prostate biopsies of targets identified by multiparametric magnetic resonance imaging (mpMRI) by comparing the results of the PrecisionPoint (PP) Transperineal Access System with the double‐freehand (DFH) technique. Patients and methods All patients who underwent cognitive transperineal prostate biopsy of mpMRI targets using the PP or DFH technique between November 2020 and September 2023 were enrolled. All data related to mpMRI target biopsies were stratified by technique, visibility in transrectal ultrasound and analysed by comparing PP versus DFH. A standardised anaesthesia protocol with 1% mepivacaine was used in all biopsies. The tolerability of the procedures was assessed using a visual analogue scale (VAS). Results The number of mpMRI targets sampled was 166 in PP and 242 in DFH. In target biopsies, the PP system was associated with better diagnostic performance for clinically significant prostate cancer (Gleason score ≥3 + 4) compared to DFH for both ultrasound‐visible targets (61.4% vs. 48.0%) and non‐visible targets (41.4% vs. 14.9%) (p = 0.02). A higher rate of positive cores was obtained from targets sampled with PP (57.7% vs. 49.6%, p = 0.0002). The PP system was associated with the retrieval of significantly longer cores (p