{
  "abstract": "Background and objective\n\nThis study evaluated the added value of systematic biopsies (SBx) in addition to targeted biopsies (TBx) for detecting upgrading during repeat biopsies on active surveillance (AS) using data from the Prostate Cancer Research International Active Surveillance study.Methods\n\nWe analyzed repeat biopsies of men who underwent magnetic resonance imaging (MRI) and SBx at diagnosis, with or without TBx depending on the presence of an MRI lesion, had at least one positive (Prostate Imaging Reporting and Data System 3-5) follow-up MRI, and received both SBx + TBx at subsequent repeat biopsy. Upgrading compared with diagnostic biopsy was assessed for TBx only, SBx only, and both, using three definitions: any upgrading, upgrading to grade group (GG) ≥2 with cribriform growth or intraductal carcinoma (≥GG2+), and upgrading to ≥GG3. Cumulative incidences were calculated using each detection method as competing events. For upgrading ≥GG2+ detected by SBx only, the laterality relative to the MRI lesion was determined.Key findings and limitations\n\nWe analyzed 650 repeat biopsies in 568 patients with a median follow-up of 3.0 yr (interquartile range = 1.8-4.3) for men still on AS. During available follow-up, any upgrading occurred in 238 biopsies (37%), of which 47 (7.2%) were detected by SBx only. Upgrading to ≥GG2+ and ≥GG3 was observed in 100 biopsies (16%) and 78 biopsies (12%), respectively, with SBx alone identifying 19 (3.0%) and 15 (2.3%) of these patients. At 6 yr, the cumulative incidence of ≥GG2+ upgrading was 27% (95% confidence interval [CI] = 21-32%), with 5.4% (95% CI = 2.9-9.1%) for upgrading detected exclusively by SBx. Three of the 19 cases with upgrading to ≥GG2+ detected by SBx only were located contralateral to the MRI lesion (0.5% of all biopsies). Limitations include the retrospective design, which may introduce selection and registration biases.Conclusions and clinical implications\n\nIn men on AS who underwent diagnostic MRI with SBx (with or without TBx) and a positive follow-up MRI, SBx has limited added value during repeat biopsies, particularly for contralateral sampling, supporting a targeted and perilesional biopsy approach.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.",
    "Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.",
    "Department of Urology, Hospital Universitario de Navarra, Pamplona, Spain.",
    "Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.",
    "Department of Urology, University Hospital Muenster, Muenster, Germany.",
    "Department of Urology, Helsinki University Hospital, Helsinki, Finland.",
    "Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.",
    "Department of Urology, Polyclinique Reims-Bezannes, Bezannes, France.",
    "Department of Urology, Kagawa University, Kagawa, Japan.",
    "Department of Urology and Neurology, Marien Hospital Herne, Herne, Germany.",
    "Department of Urology, Sint Franciscus Hospital, Rotterdam, The Netherlands."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Jeroen J Lodder",
      "orcid": "0009-0006-3457-2287"
    },
    {
      "affs": [
        0
      ],
      "name": "Sebastiaan Remmers"
    },
    {
      "affs": [
        1
      ],
      "name": "Markus Graefen"
    },
    {
      "affs": [
        2
      ],
      "name": "Francisco Lozano-Uruñuela"
    },
    {
      "affs": [
        3
      ],
      "name": "Cristina Marenghi"
    },
    {
      "affs": [
        4
      ],
      "name": "Philipp Papavassilis"
    },
    {
      "affs": [
        5
      ],
      "name": "Antti Rannikko"
    },
    {
      "affs": [
        6
      ],
      "name": "Diederik Somford"
    },
    {
      "affs": [
        7
      ],
      "name": "Frederic Staerman"
    },
    {
      "affs": [
        8
      ],
      "name": "Mikio Sugimoto"
    },
    {
      "affs": [
        9
      ],
      "name": "Karl H Tully"
    },
    {
      "affs": [
        0,
        10
      ],
      "name": "Roderick C N van den Bergh"
    },
    {
      "affs": [
        0
      ],
      "name": "Monique J Roobol"
    },
    {
      "name": "Prostate Cancer Research International: Active Surveillance (PRIAS) consortium"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bt2n6jbem00k9.bib",
  "cited_by": 0,
  "doi": "10.1016/j.euros.2026.09.006",
  "fulltext_url": "https://europepmc.org/articles/PMC13683850",
  "id": "bt2n6jbem00k9",
  "issns": [
    "2666-1691",
    "2666-1683"
  ],
  "landing_url": "https://europepmc.org/article/MED/42909178",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Prostate Cancer Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7221643418",
  "pdf_url": "https://europepmc.org/articles/PMC13683850?pdf=render",
  "pmcid": "PMC13683850",
  "pmid": "42909178",
  "published": "2026-10-13",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/bt2n6jbem00k9.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "MED:42909178",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42909178"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Prostate Cancer Diagnosis and Treatment",
      "subfield": "general"
    }
  ],
  "title": "Can We Omit Systematic Biopsies in Men with a Positive MRI During Repeat Biopsies for Active Surveillance for Prostate Cancer? Results from the PRIAS Study.",
  "title_text": "Can We Omit Systematic Biopsies in Men with a Positive MRI During Repeat Biopsies for Active Surveillance for Prostate Cancer? Results from the PRIAS Study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:10Z",
  "url": "https://research.draconitic.com/paper/bt2n6jbem00k9",
  "venue": "European urology open science",
  "versions": []
}