Individualized Decision Making in Transperineal Prostate Biopsy: Should All Men Undergo an Additional Systematic Biopsy?
, Rodrigo Suarez-Ibarrola 1, Matthias Benndorf 3, Moritz Weishaar 1, Jonathan Morlock 1, Arkadiusz Miernik 1, Christian Gratzke 1, Cordula A. Jilg 1 and Markus Grabbert 1
T.M. De Reijke
Round 1
Reviewer 1 Report
This large retrospective analysis of patients undergoing transperineal biospies is interesting, however, the conclusions cannot be translated into change in clinical practice, because data are missing.
What was reason for biopsy? (elevated PSA, followup Active surveillance, suspicious digital rectal examination)
In how many patients there was a unilateral PI-RADS 3 or higher lesion? I think only these patients should be included
Were systematic biopsies poise on the same side of the PI-RADS lesion or on the contralateral side?
ISUP 2 (Gleason 3+4) without cribriform growth pattern is not considered as significant cancer. In how many patients this was found?
Author Response
Thank you for the thoughtful revision of our manuscript.
Please find our reply in the attached file.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
The present paper aims to evaluate the benefit of the systematic biopsy to MRI-targeted biopsy in prostate cancer, concluding that the latter can be avoided in PIRADS 5 lesions.
The paper is well written and well thought, and opens a very intresting window on the mamngement of the PIRADS 5 lesions, allowing to avoid compilactions deriving from unnecessary targeted biopsy.
There are a few minor issues to be resolved.
In the introduction:
- explain the acronym "CDRs".
- there are three listed aims but the endpoint listed in the Materials and Methods are two; please, solve this discrepancy
Caption of Fig3:
- add a point after "radical prostatectomy".
Discussion:
It may benefit by a larger comparison of the data about the association between Gleason Score and the tumor volume at biopsy. Add the following reference and discuss it.
Histopathological Ratios to Predict Gleason Score Agreement between Biopsy and Radical Prostatectomy. Diagnostics (Basel). 2020 Dec 23;11(1):10. doi: 10.3390/diagnostics11010010. Fiorentino et al.
Author Response
Thank you for the thoughtful revision of our manuscript.
Please find our reply in the attached file.
Author Response File: Author Response.pdf
