FOR OVER a century, prostate biopsy (PBx) has been the cornerstone of prostate cancer (PCa) diagnosis. Yet, despite continual refinement, debate persists regarding the most effective biopsy strategy. Traditional systematic biopsy (SB) typically involves 12 cores, whereas targeted biopsy (TB), guided by multiparametric MRI (Mp-MRI), uses 3–5 cores directed at suspicious lesions. Combining both methods, such as the widely used 8PZ + 4TZ + X approach, has long been considered optimal. However, recent findings suggest this template may be less effective for detecting clinically significant PCa (csPCa) in transitional zone (TZ) tumours.
Enhancing Prostate Biopsy for Transitional Zones
The present study explored whether enhancing sampling density in the TZ could improve cancer detection. Retrospective analysis revealed that the 8PZ + 4TZ + X biopsy underdetected csPCa in TZ tumours compared with peripheral zone (PZ) tumours. This inefficiency was attributed to excessive PZ sampling and inadequate TZ representation. Researchers therefore developed the 8PZ + 10TZ + X PBx protocol, increasing TZ cores based on lesion volume and sampling density.
In a prospective clinical trial, this adjusted protocol achieved notably higher biopsy positivity and csPCa detection rates in TZ patients without increasing complication rates. Importantly, further analysis showed that omitting unnecessary PZ cores, using an 8TZ + X approach, maintained diagnostic accuracy while reducing the number of samples required. This highlights the benefit of targeted biopsy strategies that focus on lesion-specific regions, improving both efficiency and patient comfort.
Clinical Implications and Future Directions
By increasing TZ sampling and reducing redundant PZ cores, the 8TZ + X biopsy strategy enhances diagnostic precision for TZ tumours. These findings align with the growing role of MRI-guided and perilesional biopsy methods, which allow more accurate lesion localisation and improved detection of csPCa. Future research incorporating artificial intelligence and multicentre validation could further personalise prostate biopsy planning.
Overall, this study provides compelling evidence that optimising core distribution in the TZ region represents a crucial step towards more accurate, efficient, and patient-centred prostate cancer diagnosis.
Reference
Chen X et al. Optimized biopsy strategy for transition zone prostate cancer with enhanced perilesional sampling: a retrospective analysis and clinical trial validation. JCO Precis Oncol. 2025;9:e2500468.
