<p><strong>In patients undergoing repeat biopsy and who have a suspicious lesion on MRI, clinicians should perform targeted biopsies of the suspicious lesion and may also perform a systematic template biopsy. (<em>Moderate Recommendation [targeted biopsies]/Conditional Recommendation [systematic template biopsy]; Evidence Level: Grade C)</em></strong></p>
Discussion
Discussion
<p>In the repeat biopsy setting with targeted and systematic biopsy, the frequency of cancer found in systematic biopsy samples range from 5% to 10% across multiple studies.<sup>160, 295, 296</sup>While these results suggest a combined biopsy with systematic and targeted cores optimizes cancer yield, such an approach entails obtaining a larger number of cores, which may increase patient discomfort and other biopsy-associated complications,<sup>297, 298</sup> and the apparent incremental yield of off-target biopsy samples may be influenced by the sampling error associated with software image registration at targeted biopsy.<sup>299</sup> Ultimately, the decision to perform systematic sampling in addition to target sampling should be based on an integrated evaluation of MRI factors such as quality and confidence in target presence and clinical factors such as PSA, technique of initial biopsy, and time since prior systematic biopsy.</p>