To evaluate the efficacy of adding a simple prostate mapping diagram to multiparametric prostate magnetic resonance imaging (mpMRI) reports, a randomized, prospective study is designed. Despite cognitive prostate biopsy is the most preferred approach among targeted biopsy methods due to its low cost and easy application, its operator dependency requires standardization to improve diagnostic accuracy for prostate cancer (PCa).

A total of 155 patients underwent mpMRI as the standard of care and were randomly assigned in a 1:1 ratio to two groups: prostate mapping diagram and standard group. In addition to the mpMRI reports, suspicious lesions (≥PI-RADS 3) were drawn on a schematic diagram by a single specialized uro-radiologist in the prostate mapping group. A single experienced urologist sampled four cores from each target in addition to a 12-core systematic biopsy in both groups. A Gleason score of 3+4 or higher was considered as clinically significant PCa (csPCa).

Overall cancer detection rate between the group 1 and 2 was statistically significant (57% and 35%, respectively, P=.006). Particularly, csPCa rates among the groups were 47% (36/77) and 21% (16/78) for group 1 and group 2, respectively (P<.001). The csPCa detection with only targeted biopsies was strikingly as high as 3-fold (17% vs 6%, P=.048) in the mapping group.

Our prospective study has shown that the addition of a simple mapping strategy to mpMRI reports significantly increased cancer rates by cognitive biopsy. We strongly recommend the use of a schematic mapping diagram in biopsy protocols.