该研究旨在评估前列腺活检与根治性前列腺切除标本的组织病理学一致率，根据应用的活检方法（经直肠或经会阴）。我们研究了2018年至2022年间新诊断临床重要前列腺癌并行根治性前列腺切除的患者。纳入患者需进行术前磁共振成像，并且之前未接受前列腺癌治疗。将前列腺活检的组织病理分级与根治性前列腺切除标本进行比较。进行单变量和多变量 logistic 回归分析，评估活检方法对组织病理学一致性的影响。另外进行分析，评估活检方法对美国泌尿学会风险分组的迁移效应，定义为根治性前列腺切除后风险分组的任何变化。共研究了1058名男性受试者，其中49.3％（522/1058）接受经直肠前列腺活检，50.7％（536/1058）接受经会阴前列腺活检。发现37.8％（400/1058）的男性存在组织病理不一致，30.2％（320/1058）的男性存在美国泌尿学会风险分组的迁移。与经直肠活检相比，经会阴活检方法与更高的组织病理学一致率（OR 1.33 [95% CI 1.01-1.75], p = 0.04）及较少的美国泌尿学会风险分组迁移（OR 0.70 [95% CI 0.52-0.93], p = 0.01）相关联。与经直肠活检相比，经会阴活检方法可提高组织病理学一致率。经会阴活检方法可能为临床决策提供更准确的风险分层。尽管近年来有所改善，但组织病理学一致性仍不理想，在开始管理之前应予考虑。© 2023年作者，排他许可给Springer Nature Limited。

This study aimed to evaluate the histopathological concordance rates between prostate biopsies and radical prostatectomy specimens according to the applied biopsy approach (transrectal or transperineal).We studied patients who had been newly diagnosed with clinically significant prostate cancer and who underwent a radical prostatectomy between 2018 and 2022. Patients were included if they underwent a prebiopsy magnetic resonance imaging and if they had not been previously treated for prostate cancer. Histopathological grading on prostate biopsies was compared with that on radical prostatectomy specimens. Univariable and multivariable logistic regression analyses were performed to assess the effect of the applied biopsy approach on histopathological concordance. Additional analyses were performed to assess the effect of the applied biopsy approach on American Urological Association risk group migration, defined as any change in risk group after radical prostatectomy.In total, 1058 men were studied, of whom 49.3% (522/1058) and 50.7% (536/1058) underwent transrectal and transperineal prostate biopsies, respectively. Histopathological disconcordance was observed in 37.8% (400/1058) of men while American Urological Association risk group migration was observed in 30.2% (320/1058) of men. A transperineal biopsy approach was found to be independently associated with higher histopathological concordance rates (OR 1.33 [95% CI 1.01-1.75], p = 0.04) and less American Urological Association risk group migration (OR 0.70 [95% CI 0.52-0.93], p = 0.01).The use of a transperineal biopsy approach improved histopathological concordance rates compared to the use of a transrectal biopsy approach. A transperineal biopsy approach may provide more accurate risk stratification for clinical decision-making. Despite recent improvements, histopathologic concordance remains suboptimal and should be considered before initiating management.© 2023. The Author(s), under exclusive licence to Springer Nature Limited.