经MRI靶向活检（TBx）诊断的男性患者中，经阴道会阴与经直肠活检与根治性前列腺切除（RP）标本的整合率评估不足。本研究旨在评估国际泌尿病理学会（ISUP）从活检角度出发在RP术后并结合MRI-TBx和随机活检（RB）进行的最终病理学结果之间的整合率，比较经TP-TBx和经TR-TBx的生物检测方式。本多机构数据库纳入了接受RP治疗的经TP或经TR诊断的患者。本研究比较了活检时的ISUP分级和最终病理学结果。使用多元逻辑回归分析（MVA）来评估活检方法（TP-TBx vs TR-TBx）与ISUP升级、降级、整合率和临床相关性的提高之间的关联。总共有752（59％）经TR而有530（41％）经TP活检的患者。在MVA中，TP-TBx是升级的独立预测因素（比值比[OR]为0.6，95％置信区间[CI]为0.4〜0.9，P＜0.01），并在年龄、cT分期、前列腺成像报告和数据系统、靶向反应区域、前列腺特异性抗原和前列腺体积进行校正后，与最终病理学结果的整合率改善相关（OR 1.7，95％ CI 1.2〜2.5，P＜0.01）。此外，与TR-TBx相比，TP-TBx与CRI的风险较低（OR为0.7，P＜0.01）。在考虑接受MRI-TBx + RB的患者时，这个结论依然适用（OR 0.6，P＜0.01）。包括RP的患者可能存在选择性偏倚。采用TP-TBx而非TR-TBx可能降低升级的风险、提高生物检测级别与最终病理学结果之间的整合性。TP-TBx的方法可以减少CRI的发生风险，同时针对正确的主动治疗改善患者的选择。我们在这项研究中评估了TP-TBx相对于TR-TBx在大型全球人群中改善与最终病理学结果符合的临床重要性前列腺癌的一致性。我们发现，与TR-TBx相比，TP-TBx可以提高一致性。尽管TP方法已经被采用来增加精度，但整合性仍有待改善。版权所有©2023欧洲泌尿外科协会。由Elsevier B.V.出版。保留所有权利。

The concordance rates of transperineal (TP) versus transrectal (TR) prostate biopsies with radical prostatectomy (RP) specimen have been assessed poorly in men diagnosed with magnetic resonance imaging (MRI)-targeted biopsy (TBx).To evaluate International Society of Urological Pathology (ISUP) concordance rates between the final pathology at RP and MRI-TBx or MRI-TBx + random biopsy (RB) according to the biopsy approach.A multi-institutional database included patients diagnosed with TP or TR treated with RP.TP-TBx or TR-TBx of the prostate.The ISUP grade at biopsy was compared with the final pathology. A multivariable logistic regression analysis (MVA) was performed to assess the association between the biopsy approach (TP-TBx vs TR-TBx) and ISUP upgrading, downgrading, concordance, and clinically relevant increase (CRI).Overall, 752 (59%) versus 530 (41%) patients underwent TR versus TP. At the MVA, TP-TBx was an independent predictor of upgrading (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4-0.9, p < 0.01) and improved concordance relative to the final pathology (OR 1.7, 95% CI 1.2-2.5, p < 0.01) after adjusting for age, cT stage, Prostate Imaging Reporting and Data System, number of targeted cores, prostate-specific antigen, and prostate volume. Moreover, TP-TBx was associated with a lower risk of CRI than TR-TBx (OR 0.7, p < 0.01). This held true when considering patients who underwent MRI-TBx + RB (OR 0.6, p < 0.01). The inclusion of men who had RP represents a potential selection bias.The adoption of TP-TBx compared with TR-TBx may reduce the risk of upgrading and improve the concordance of biopsy grade with the final pathology. The TP approach decreases the odds of CRI with improved patient selection for the correct active treatment.In this report, we evaluated whether transperineal (TP) targeted biopsy (TBx) may improve the concordance of clinically significant prostate cancer with the final pathology in comparison with transrectal (TR) TBx in a large worldwide population. We found that TP-TBx might increase concordance compared with TR-TBx. Adding random biopsies to target one increases accuracy; however, concordance with the final pathology is overall suboptimal even with the TP approach.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.