根据在未进行活检的患者中进行的不同试验的结果，mpMRI引导下的经直肠超声融合活检（FB）期间的目标活检（TB）加随机活检（RB）通常也被用于主动监测（AS）计划期间进行的活检。目前，对于手术的范围和方式缺乏明确的共识。为了评估在 AS 方案中进行 FB 期间通过病灶周围活检 (PL) 和不同 RB 方案所实现的诊断准确性的提高。我们前瞻性地收集了 112 例患者的数据连续患有低风险或极低风险前列腺癌的患者；阳性 mpMRI 在 AS 方案的背景下在单一学术机构进行了活检。mpMRI/经直肠 US FB，采用日立 RVS 系统，具有 3 TB 和并发经直肠 24 核 RB。不同可能活检方案的诊断率（仅 TB；仅 TB；通过 McNemar 测试比较 TB 4 个病灶周围 (PL) 核心；TB 12 核心 RB；TB 24 核心 RB）。采用单变量和多变量回归分析来确定任何癌症、格里森分级组 (GGG) ≥ 2 种癌症以及仅在较大方案中存在 GGG ≥ 2 种癌症的预测因子。GGG ≥ 2 种癌症的检出率增加至 30%通过向 TB 核心添加 4 个 PL 核心、14 个和 24 个 RB 核心，分别提高 39% 和 49%（所有 p 值 <0.01）。总体而言，仅 TB、14 核 RB 和 24 核 RB 识别出所有 GGG ≥2 癌症的 38%、47% 和 56%。通过添加 TB 4 PL 核心，该数字增加至 62%，通过添加 14 RB 核心，该数字增加至 80%。大多数差异在 PI-RADS 4 病变中观察到。我们发现，与单独结核病相比，PL 活检提高了 GGG ≥2 癌症的检出率。然而，这些核心的组合遗漏了很大一部分通过较大 RB 核心识别出的 CS 癌症，其中包括仅通过 TB 加 24 核 RB 组合诊断的 20% CS 癌症。© 2023。作者，获得施普林格自然有限公司的独家许可。

Based on the findings of different trials in biopsy naïve patients, target biopsy (TB) plus random biopsy (RB) during mpMRI-guided transrectal ultrasound fusion biopsy (FB) are often also adopted for the biopsy performed during active surveillance (AS) programs. At the moment, a clear consensus on the extent and modalities of the procedure is lacking.To evaluate the increase in diagnostic accuracy achieved by perilesional biopsy (PL) and different RB schemes during FB performed in AS protocol.We collected prospectively the data of 112 consecutive patients with low- or very-low-risk prostate cancer; positive mpMRI underwent biopsy at a single academic institution in the context of an AS protocol.mpMRI/transrectal US FB with Hitachi RVS system with 3 TB and concurrent transrectal 24-core RB.The diagnostic yield of the different possible biopsy schemes (TB only; TB + 4 perilesional (PL) cores; TB + 12-core RB; TB + 24-core RB) was compared by the McNemar test. Univariable and multivariable regression analyses were adopted to identify predictors of any cancer, Gleason grade group (GGG) ≥2 cancers, and the presence of GGG≥2 cancers in the larger schemes only.The detection rate of GGG ≥2 cancers increased to 30%, 39%, and 49% by adding 4 PL cores, 14, and 24 RB cores, respectively, to TB cores (all p values <0.01). On the whole, TB alone, 14-core RB, and 24-core-RB identified 38%, 47%, and 56% of all the GGG ≥2 cancers. Such figures increased to 62% by adding to TB 4 PL cores, and to 80% by adding 14 RB cores. Most of the differences were observed in PI-RADS 4 lesions.We found that PL biopsy increased the detection rate of GGG ≥2 cancers as compared with TB alone. However, the combination of those cores missed a large percentage of the CS cancers identified with larger RB cores, including a 20% of CS cancers diagnosed only by the combination of TB plus 24-core RB.© 2023. The Author(s), under exclusive licence to Springer Nature Limited.