Original scientific paper

https://doi.org/10.20471/acc.2026.65.02.06

Prostate Biopsy Results in the PSA Gray Zone: A Five-Year Retrospective Study

Tomislav Kuliš orcid.org/0000-0002-0895-5691 ; School of Medicine, University of Zagreb, Zagreb, Croatia; Department of Urology, University Hospital Centre Zagreb, Zagreb, Croatia *
Toni Kelava ; School of Medicine, University of Zagreb, Zagreb, Croatia
Toni Zekulić orcid.org/0000-0002-3498-0217 ; Department of Urology, University Hospital Centre Zagreb, Zagreb, Croatia
Luka Penezić ; Department of Urology, University Hospital Centre Zagreb, Zagreb, Croatia
Jerko Anđelić ; Department of Urology, University Hospital Centre Zagreb, Zagreb, Croatia
Tomislav Sambolić ; Department of Urology, University Hospital Centre Zagreb, Zagreb, Croatia
Željko Kaštelan ; School of Medicine, University of Zagreb, Zagreb, Croatia; Department of Urology, University Hospital Centre Zagreb, Zagreb, Croatia

* Corresponding author.

Abstract

Our aim was to analyze and compare the diagnostic efficacy of systematic and
targeted + systematic prostate biopsies in patients with prostate-specific antigen
(PSA) levels of 4–10 ng/mL.
A retrospective study was conducted at University Hospital Centre Zagreb by
analyzing biopsy data from 2018 to 2023. A total of 2,466 patients met the inclusion
criteria, undergoing either a systematic (n = 1,900) or a combined targeted
+ systematic biopsy (n = 566). Targeted biopsies were performed for patients
with a Prostate Imaging-Reporting and Data System (PIRADS) score ≥ 3 on multiparametric
magnetic resonance imaging (mpMRI). Cancer detection rates and
Gleason score (GS) distributions were evaluated.
Prostate cancer (PC) was diagnosed in 41% of the study cohort. The detection
rate was higher in the targeted + systematic biopsy group (54.7%) than in
the systematic biopsy group (38.2%). Among biopsy-naïve patients, targeted +
systematic biopsy yielded a detection rate of 72.7%, significantly higher than
systematic biopsy alone (42.1%). Clinically significant PC (ISUP ≥ 2) was detected
in 35.2% of all cases, with targeted biopsies identifying a higher proportion of
clinically significant tumors. Operator bias was observed, as systematic cores in
targeted biopsy patients often contained malignant cells.
The combination of targeted and systematic biopsies demonstrated the highest
detection rate of clinically significant prostate cancer, particularly in biopsy-
naïve patients. Given the increasing use of mpMRI, this approach should be
considered the method of choice for patients with elevated PSA levels. Future
studies should assess the financial feasibility of widespread mpMRI implementation
in prostate cancer diagnostics.

Keywords

Multiparametric magnetic resonance imaging for prostate; Prostate-specific antigen; Prostate biopsy; Prostate cancer

Hrčak ID:

347691

URI

https://hrcak.srce.hr/347691

Publication date:

10.6.2026.

Article data in other languages: croatian

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