Table 1:

Patient Groups and Proposed MRI-directed Biopsy Strategies according to PI-RADS Categorization

Note.—For transrectal US biopsy, 10–12 systematic transrectal US-guided core biopsies are performed, as per international standards. Saturation biopsy is performed by using transrectal or transperineal sampling (eg, Ginsburg approach). Focal saturation biopsy involves four or more cores for each MRI target, including surrounding sextants. MRDB = MRI-directed biopsy using US/MRI or the in-bore technique with two to four cores per lesion. PI-RADS = Prostate Imaging Reporting and Data System, TPMB = transperineal mapping biopsy.

*Higher risk based on clinical suspicion, family history, prior biopsy result, and biomarkers, including 4 K, prostate health index, prostate cancer gene 3, family history, prostate-specific antigen (PSA) density, and risk calculator scores alone or in combination. 4K incorporates a panel of four kallikrein protein biomarkers (total PSA level, free PSA level, intact PSA level, and human kallikrein-related peptidase 2 level) and other clinical information in an algorithm that provides a percentage risk for clinically significant (Gleason grade ≥7) cancer seen at transrectal US biopsy.

^†American Urological Association/Society of Abdominal Radiology 2016 guidelines (79)

^‡European Association of Urology 2019 prostate guidelines (https://uroweb.org/guideline/prostate-cancer/) (13).

^#National Health Service in England, 2018 (83).

^§National Comprehensive Cancer Network version 1.2019 Prostate Cancer Early Detection Recommendations (https://www.nccn.org/) (12).

^||Safety net monitoring consists of prostate-specific antigen level monitoring and follow-up imaging, as per local clinical practice and consistent with clinical goals in individual patients, with roles and responsibilities defined by multidisciplinary management teams.

**NICE guideline proposal 2019 (https://www.nice.org.uk/guidance/indevelopment/gid-ng10057) (31).

^††Dependent on the size and likely next step in management if clinically important prostate cancer is found.