Are Novice Resident Physicians Capable of Executing Freehand Cognitive Fusion Transperineal Prostate Biopsies ?

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Yize Guo, Bin Li, Yongchao Yan, Xuemei Ding, Yanjiang Li, Wei Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4834515/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The study aimed to evaluate the differences in prostate cancer (PCa) detection rates between novice and experienced resident physicians using free-hand cognitive fusion transperineal prostate biopsy (fTP-Bx) through propensity score matching (PSM). Methods A retrospective analysis was conducted on a cohort of patients who underwent fTP-Bx procedures. The needle biopsies were performed by two groups of surgical doctors with varying levels of prostate biopsy experience (Novice Group and Experienced Group) between March 1, 2023, and March 1, 2024. The PSM method was employed to compare the differences in cancer detection-related parameters between various groups of differing prostate biopsy experience levels. Results In total, 398 patients were included in the study, with 196 in the Experienced Group and 202 in the Novice Group. Prior to PSM, significant differences were observed between the groups in terms of operation duration (p = 0.014) and multiparametric MRI results (mpMRI, p = 0.009). However, after adjusting for confounding factors through PSM, there were no differences in the absolute number of cores involved, percentage of cores involved, clinically significant prostate cancer (csPCa) detection rates, and overall PCa detection rates between the different prostate biopsy experience groups. Despite potential variations in operation duration related to different levels of needle biopsy experience, there were no distinctions observed between novice and experienced doctors in terms of prostate cancer detection, particularly concerning csPCa. Conclusions Novice resident physicians have the ability to complete qualified fTP-Bx. Prostate cancer Free-hand cognitive fusion transperineal prostate biopsy Propensity score matching Clinically significant prostate cancer Figures Figure 1 Figure 2 Introduction Prostate Cancer (PCa) is the second most commonly diagnosed cancer worldwide in 2022, also ranking as the fifth leading cause of cancer-related deaths in men [ 1 ]. Prostate-specific antigen (PSA) screening has significantly improved the early diagnosis rate of PCa, leading to a gradual decrease in mortality rates [ 2 – 4 ]. Despite the introduction of various new diagnostic tools and biomarkers that enhance the accuracy of early PCa detection, prostate biopsy remains the primary method for definitive diagnosis [ 5 ]. While MRI-guided targeted biopsy offers higher accuracy and lower complication rates, its high hardware requirements have hindered widespread adoption, making ultrasound-guided prostate biopsy the predominant approach. Studies indicate that although transrectal prostate biopsy covers a wider range [ 6 ], the detection rates between transrectal and transperineal biopsies are comparable, with the latter associated with a lower risk of infection [ 7 ]. It has thus become a trend to shift from transrectal to transperineal biopsies [ 8 ]. In prostate biopsy, the two main auxiliary targeting methods are cognitive fusion biopsy [ 9 ]and image fusion biopsy [ 10 , 11 ], with the former being more widely used in clinical practice due to its lack of specific hardware requirements. While some centers use template-guided biopsies [ 12 ], free-hand cognitive fusion transperineal prostate biopsy (fTP-Bx) is more common [ 13 ]. This is mainly because fTP-Bx has lower hardware requirements and its complication rate and detection rate for clinically significant prostate cancer (csPCa) are not significantly inferior to other biopsy methods [ 14 , 15 ]. The operator’s experience is a crucial factor influencing the effectiveness of various medical procedures [ 16 – 18 ]. Previous studies have shown that the results of MR-guided targeted biopsy of the prostate performed by the same operator are closely related to the biopsy experience. With the accumulation of biopsy experience, the accuracy of the biopsy improves, and the operation time is significantly reduced [ 19 ]. Through the summary of experiences in transperineal prostate biopsy, it was found that native residents can achieve a high PCa detection rate after brief training [ 20 ]. It is foreseeable that with the increase of biopsy experience, the detection rate of small tumors will gradually increase for the same physician [ 21 ]. In addition, studies indicate that during local anesthesia prostate biopsy, novice physicians exacerbate the pain level for patients compared to experienced physicians [ 22 ]. Although there is no significant correlation between the detection rate of csPCa and the experience of the operating surgeon during robot-assisted prostate biopsy [ 23 ], for fTP-Bx, there is still a need for further research on whether there is a significant difference in the detection rate of csPCa among operators with different biopsy experiences, especially among the group of operators primarily responsible for fTP-Bx (including novice and experienced resident physicians). This issue is significant enough to affect patient education on prostate biopsy and clinical practice. To address the above clinical question, this study collected clinical data related to 398 cases of fTP-Bx conducted in our hospital and, through the use of propensity score matching (PSM), compared the absolute number of cores involved, percentage of cores involved, csPCa detection rates, and overall PCa detection rates between the different prostate biopsy experience groups. Materials and methods Patients A total of 398 patients who underwent fTP-Bx in the Department of Urology at the Affiliated Hospital of Qingdao University from March 1, 2023, to March 1, 2024, were included in the study. They were divided into two groups: the Experienced Group and the Novice Group. The Novice Group consisted of two residents with less than 10 cases of experience in prostate biopsy, while the Experienced Group consisted of two residents with over 100 cases of experience in prostate biopsy. The Experienced Group had 196 patients, and the Novice Group had 202 patients. This study was approved by the Medical Ethics Committee of the Affiliated Hospital of Qingdao University, with approval number QYFY WZLL 28966. Strategy of fTP-Bx Due to the higher detection rate of csPCa with the combination of target and systematic cores [ 24 ], all patients underwent free-hand transperineal targeted biopsy and additionally a transperineal systematic biopsy [ 25 ]. Anesthesia options included local anesthesia and general anesthesia, with the decision jointly made by the patient, surgeon, and anesthesiologist. Demographic Data and Evaluation Indicators Collect preoperative information of patients: age, body mass index (BMI), prostatic acid phosphatase (PAP), total prostate-specific antigen (TPSA), PSA density (PSAD), prostate volume, prostate anteroposterior diameters, prostate transverse diameters, prostate axial diameters, Prostate Imaging-Reporting and Data System (PI-RADS), operation time, and anesthesia method. Postoperative pathological specimens were evaluated by two senior pathologists. The mpMRI includes T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences. Pathological results include total number of cores, the absolute number of cores involved, percentage of cores involved (absolute number of cores involved / total number of cores), percentage of one needle PCa, csPCa (Gleason score ≥ 3 + 4 = 7) detection rates, and overall PCa detection rates and World Health Organization / International Society of Urological Pathology (WHO/ISUP) classification. Statistical Methods Statistical analysis was conducted using SPSS 25.0 software. PSM was used to match the two groups of patients. Initially, covariates such as age, BMI, PAP, anteroposterior diameters, transverse diameters, axial diameters, prostate volume, TPSA, PSAD, PI-RADS, operation time, anesthesia type, etc., were used as matching factors, and logistic regression analysis was employed to estimate the propensity score. Subsequently, nearest neighbor matching method and caliper value rule of 0.25 were used for 1:1 case matching. After matching, continuous data following normal distribution were expressed as Mean ± SD and compared between groups using t-test; while data following skewed distribution were expressed as Median (1st Quartile, 3st Quartile) and compared between groups using Mann-Whitney test. Count data results were presented as n (%) and analyzed using χ2 test or Fisher’s exact test. All statistical analyses were two-tailed tests, and a P < 0.05 was considered statistically significant. Results Clinical Characteristics of Patients in Different Groups The clinical characteristics of patients in different groups are described in Table 1 . Before PSM, the Experienced Group and Novice Group enrolled 196 and 202 patients, respectively. Among all covariates, surgical time and mpMRI scores showed statistical differences. The Novice Group had a longer average surgical time ( P = 0.014). In terms of mpMRI scoring, the two groups of patients demonstrated different distribution trends. A higher proportion of patients with high PI-RADS (≥ 4) was observed in the Experienced Group, while more patients in the Novice Group had PI-RADS 0.05). Probability density analyses before and after PSM demonstrated a good matching effect (Fig. 1). Standard Mean Difference (SMD) analysis showed that covariates represented by TPSA had higher SMD values, whereas after PSM, the SMD values of all covariates were controlled below 0.2 (Fig. 2 ). Table 1 Descriptive statistics of the entire cohort Variables Before PSM After PSM Experienced Group (n = 196) Novice Group (n = 202) P SMD Experienced Group (n = 146) Novice Group (n = 146) P SMD Age, Mean ± SD 69.51 ± 7.52 68.48 ± 7.39 0.167 t -0.140 68.64 ± 7.61 68.50 ± 7.41 0.876 t -0.018 BMI, Mean ± SD 23.99 ± 3.07 24.52 ± 3.27 0.101 t 0.162 24.09 ± 2.98 24.56 ± 3.25 0.200 t 0.144 Anteroposterior diameters, Mean ± SD 4.31 ± 0.91 4.32 ± 0.95 0.874 t 0.017 4.29 ± 0.93 4.33 ± 0.97 0.739 t 0.038 Transverse diameters, Mean ± SD 5.29 ± 0.72 5.28 ± 0.90 0.905 t -0.011 5.29 ± 0.76 5.28 ± 0.90 0.906 t -0.013 Axial diameters, Mean ± SD 4.82 ± 1.15 4.80 ± 1.07 0.856 t -0.020 4.77 ± 1.17 4.79 ± 1.08 0.873 t 0.020 Operation time, M (Q₁, Q₃) 20.00 (15.00, 25.00) 20.00 (15.00, 25.00) 0.014 U 0.189 20.00 (15.00, 25.00) 20.00 (15.00, 25.00) 0.272 U 0.057 TPSA, M (Q₁, Q₃) 11.31 (6.56, 27.52) 10.74 (6.95, 19.90) 0.615 U -0.641 9.68 (6.26, 17.75) 11.16 (6.93, 21.54) 0.255 U 0.064 Prostate volume, M (Q₁, Q₃) 55.49 (38.18, 73.25) 55.97 (38.44, 75.40) 0.910 U 0.001 54.12 (37.37, 71.45) 55.81 (35.68, 76.69) 0.800 U 0.022 PSAD, M (Q₁, Q₃) 0.18 (0.12, 0.53) 0.20 (0.12, 0.40) 0.945 U -0.172 0.18 (0.12, 0.32) 0.20 (0.12, 0.40) 0.240 U 0.049 Anesthesia, n (%) 0.230 C 0.340 C Local anesthesia 58 (29.59) 49 (24.26) -0.124 39 (26.71) 32 (21.92) -0.116 General anesthesia 138 (70.41) 153 (75.74) 0.124 107 (73.29) 114 (78.08) 0.116 mpMRI, n (%) 0.009 C 0.399 C PI-RADS ≤ 2 65 (35.52) 76 (40.43) 0.100 57 (39.04) 55 (37.67) -0.028 PI-RADS = 3 51 (27.87) 70 (37.23) 0.194 47 (32.19) 57 (39.04) 0.140 PI-RADS ≥ 4 67 (36.61) 42 (22.34) -0.343 42 (28.77) 34 (23.29) -0.130 SD: standard deviation, M: Median, Q₁: 1st Quartile, Q₃: 3st Quartile t t-test; U Mann-Whitney test; C Chi-square test Inter-group comparison of PCa detection rate. We used six parameters respectively to fully evaluate the differences in the efficacy of prostate biopsies between two groups. The results showed that there were no significant differences between operators with different levels of experience in terms of the detection rates of PCa or csPCa, the malignancy of the detected tumors, or the rate of one needle PCa( P > 0.05, Table 2 ). Table 2 Comparison of the diagnostic efficacy of PCa between two groups of surgeons Variables Before PSM After PSM Experienced Group (n = 196) Novice Group (n = 202) P Experienced Group (n = 146) Novice Group (n = 146) P Absolute number of cores involved, M (Q₁, Q₃) 7.00 (3.00, 11.00) 7.00 (4.00, 11.00) 0.746 U 6.50 (3.25, 9.75) 7.00 (4.00, 11.00) 0.416 U Percentage of cores involved, M (Q₁, Q₃) 0.57 (0.23, 0.97) 0.57 (0.29, 0.93) 0.616 U 0.50 (0.23, 0.91) 0.59 (0.29, 0.93) 0.538 U One needle PCa, n(%) 0.692 C 0.709 C No 87 (91.58) 80 (89.89) 53 (91.38) 59 (89.39) Yes 8 (8.42) 9 (10.11) 5 (8.62) 7 (10.61) PCa, n(%) 0.378 C 0.344 C No 101 (51.53) 113 (55.94) 88 (60.27) 80 (54.79) Yes 95 (48.47) 89 (44.06) 58 (39.73) 66 (45.21) csPCa, n(%) 1.000 C 0.926 C No 2 (2.22) 2 (2.44) 2 (3.70) 1 (1.67) Yes 88 (97.78) 80 (97.56) 52 (96.30) 59 (98.33) WHO/ISUP classification, n(%) 0.107 C 0.95 C 4 40 (42.55) 26 (29.21) 19 (33.33) 21 (31.82) SD: standard deviation, M: Median, Q₁: 1st Quartile, Q₃: 3st Quartile t t-test; U Mann-Whitney test; C Chi-square test Discussion There are many factors that influence the results of prostate biopsy, so excluding a large number of confounding factors is necessary when comparing the biopsy effects of different operators. PSM is a better analytical strategy used in clinical research to control confounding factors [ 26 , 27 ]. This study used PSM to balance the confounding factors in the baseline information and evaluated the differences in biopsy results between different groups. Among the confounding factors included in this study, TPSA, PSAD, prostate volume, and PI-RADS have been proven to affect the positive rate of prostate biopsy [ 28 ]. There were inter-group differences in the baseline mpMRI PI-RADS scores of the two groups, which were calibrated by PSM. Age progression is a clear risk factor for PCa and has been included as a confounding factor for balance [ 1 ]. There is also some research evidence regarding the correlation between BMI and PCa, for example, BMI can increase the risk of developing PCa [ 29 ], and overweight and obese PCa patients have a higher risk of lymph node metastasis compared to PCa patients with normal BMI [ 30 ], so this study also includes BMI as a balancing factor. The reason for including PAP as a confounding factor is that as a nonspecific alkaline phosphatase synthesized in prostate epithelial cells, PAP levels increase proportionally with the progression of PCa [ 31 ], and recent studies have reported that the plasmid DNA vaccine encoding PAP (pTVG-HP) has made some progress in treating metastatic castration-resistant PCa patients [ 32 , 33 ]. There is currently no research exploring the effects of the anteroposterior diameters, transverse diameters, and axial diameters of the prostate on the positive rate of prostate biopsy. This study found differences in the detection rate of PCa based on three-dimensional diameters in a small sample pre-experiment, but unfortunately, this significant difference disappeared after including all study samples. Whether transrectal or transperineal, the same operator can significantly shorten the operation time with the accumulation of surgical experience [ 19 , 34 ]. Similarly, this study also found that the Novice Group had a longer operation time, and the length of the operation time may be influenced by the distribution and size of the lesion, so matching the operation time eliminated this confounding factor. As mentioned above, the choice of anesthesia is decided jointly by the patient, the operator, and the anesthesiologist. It has been found in a study that performing a transperineal prostate biopsy under local anesthesia can cause moderate pain, but the pain does not affect the detection rate of csPCa [ 35 ]. Nonetheless, this study still includes the type of anesthesia as one of the matching factors. Despite the gradual stabilization of tumor detection rates with the accumulation of puncture experience by the same operator [ 36 , 37 ], whether there is necessarily a significant difference between operators with different levels of experience has not been fully confirmed by research. Novice resident physicians and Experienced resident physicians are the main workforce responsible for fTP-Bx in various urology centers, so this study specifically explored these two groups. The study found that before PSM, the puncture positive rates of the Experienced Group and the Novice Group were 48.47% and 44.06%, respectively ( P = 0.378). After PSM, there was still no significant difference in the puncture positive rates between the two groups ( P = 0.344), and similarly, there was no inter-group difference in csPCa detection rate. Upon further refinement of the indicators, the percentage of cores involved in both groups was also evenly comparable. The One needle PCa detection rate was included to assess puncture accuracy under extreme conditions, and the results showed that the rates in both groups were between 8–10% with no inter-group differences. Finally, among the detected PCa cases, the proportions of patients with different WHO/ISUP classifications were similar. These results fully confirm that the cancer detection efficacy of Novice resident physicians performing fTP-Bx is comparable to that of Experienced resident physicians. When communicating with patients and their families, it can confidently be stated that the efficacy of Novice resident physicians in performing fTP-Bx is reliable. This study has certain limitations. Firstly, the study did not delve into the learning curve of fTP-Bx. Some studies have shown that after transperineal prostate biopsy, 12 cases reached the learning improvement stage, and 80 cases reached the proficiency stage. This study lacks exploration of the thresholds related to the effectiveness of biopsy by different operators. Secondly, the diameter of the lesion can affect the positive rate of prostate biopsy, and our study did not include this factor for matching because the original report did not contain relevant data. Re-measuring during the study process would introduce new bias [ 38 , 39 ]. Lastly, the study did not explore the inter-group differences in biopsy complications, mainly including pain and infection. Because this study is retrospective, there was a delay in collecting indicators such as pain, which could introduce recall bias. Additionally, all patients in this center received prophylactic levofloxacin before surgery, and patients left the hospital within 24 hours after completing the biopsy. Therefore, the original data did not contain detailed infection-related indicators [ 40 ]. Conclusions Novice resident physicians using fTP-Bx show no difference in detecting PCa compared to experienced resident physicians, indicating that novice resident physicians are capable of executing fTP-Bx work well. Abbreviations PCa prostate Cancer PSA prostate-specific antigen fTP-Bx free-hand cognitive fusion transperineal prostate biopsy csPCa clinically significant prostate cancer PSM propensity score matching BMI body mass index PAP prostatic acid phosphatase TPSA total prostate-specific antigen PSAD PSA density PI-RADS Prostate Imaging-Reporting and Data System WHO/ISUP World Health Organization / International Society of Urological Pathology SMD Standard Mean Difference Declarations Acknowledgements Not applicable. Author contributions Yize Guo and Bin Li conceived the study design, and Yanjiang Li and Wei Zhang supervised the project. Yongchao Yan and Xuemei Ding helped collect the clinical information of patients who underwent fTP-Bx in the Department of Urology. Yize Guo and Bin Li performed the analysis of the results. Yize Guo edited the first manuscript, and Yanjiang Li and Wei Zhang revised it. Finally, all the authors reviewed this article. The authors read and approved the final manuscript. Funding This work was funded by the Youth Research Fund of Qingdao University Affiliated Hospital (QDFYQN2023119). Ethics approval and consent to participate The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part are appropriately investigated and resolved. This study was performed in accordance with the principles of the Declaration of Helsinki. The research protocol of this study was approved by the Ethics Committee of the Affiliated Hospital of Qingdao University (Approval No. QYFY WZLL 28966, approval date: 26 July 2024). The informed consent requirement for this study was waived with the approval of the Ethics Committee of the Affiliated Hospital of Qingdao University because the study was conducted retrospectively and the opportunity to refuse was guaranteed. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details 1 Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China References Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A: Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries . CA: a cancer journal for clinicians 2024, 74 (3):229-263. Center MM, Jemal A, Lortet-Tieulent J, Ward E, Ferlay J, Brawley O, Bray F: International variation in prostate cancer incidence and mortality rates . European urology 2012, 61 (6):1079-1092. Kvåle R, Auvinen A, Adami HO, Klint A, Hernes E, Møller B, Pukkala E, Storm HH, Tryggvadottir L, Tretli S et al : Interpreting trends in prostate cancer incidence and mortality in the five Nordic countries . Journal of the National Cancer Institute 2007, 99 (24):1881-1887. 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The Journal of urology 2018, 200 (5):1022-1029. Song G, Ruan M, Wang H, Fan Y, He Q, Lin Z, Li X, Li P, Wang X, He Z et al : How Many Targeted Biopsy Cores are Needed for Clinically Significant Prostate Cancer Detection during Transperineal Magnetic Resonance Imaging Ultrasound Fusion Biopsy? The Journal of urology 2020, 204 (6):1202-1208. Porpiglia F, Checcucci E, S DEC, Piramide F, Amparore D, Piana A, Volpi G, Granato S, Zamengo D, Stura I et al : A prospective randomized controlled trial comparing target prostate biopsy alone approach vs. target plus standard in naïve patients with positive mpMRI . Minerva urology and nephrology 2023, 75 (1):31-41. Pradere B, Veeratterapillay R, Dimitropoulos K, Yuan Y, Omar MI, MacLennan S, Cai T, Bruyère F, Bartoletti R, Köves B et al : Nonantibiotic Strategies for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis . The Journal of urology 2021, 205 (3):653-663. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4834515","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":336708603,"identity":"e4b93808-058c-4f88-af1f-09aed6806442","order_by":0,"name":"Yize Guo","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Yize","middleName":"","lastName":"Guo","suffix":""},{"id":336708604,"identity":"eedb2a00-7235-4353-9e2b-c13b448787ce","order_by":1,"name":"Bin Li","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Li","suffix":""},{"id":336708605,"identity":"ce356f07-1694-4d94-b18c-96b6b10b01f4","order_by":2,"name":"Yongchao Yan","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Yongchao","middleName":"","lastName":"Yan","suffix":""},{"id":336708606,"identity":"9edbe61a-7126-4e06-b75b-eeffac286a68","order_by":3,"name":"Xuemei Ding","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Xuemei","middleName":"","lastName":"Ding","suffix":""},{"id":336708607,"identity":"d38dc45e-e7c3-4efd-9b2d-3e3f97e6493a","order_by":4,"name":"Yanjiang Li","email":"","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Yanjiang","middleName":"","lastName":"Li","suffix":""},{"id":336708608,"identity":"5764eb44-8f79-467c-8dcc-e903c58b62c0","order_by":5,"name":"Wei Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYBACNvmHDQcSDCSY+ZmZDzA2gIQOENDCx5DceOBBgQ27ZHtbAnFa5BjSmw8++JDGb3DmjAFxWtgYDoIcdlhackbOt4cz2xjk+G4kMH4uwKeFsRGsxZhfIne74cY2BmPJGwnM0jPwaWFmBGtJlpyRu03yYRtD4oYbCWzMPPi0sEG01G+4kfMMpKWesBYesJY0ZqD32SSBDkswIKhFAqzFhhkYyOaGM85JGM4887BZGp8W+Rnsjz/++AOOymcPe8ps5PmOJx/8jE8Lio1ALAHEkOghWssoGAWjYBSMAkwAAJJOUqa/A227AAAAAElFTkSuQmCC","orcid":"","institution":"The Affiliated Hospital of Qingdao University","correspondingAuthor":true,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-07-31 10:06:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4834515/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4834515/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64009013,"identity":"960c07c9-565c-4cfd-bf02-9328bdfec404","added_by":"auto","created_at":"2024-09-04 23:10:50","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":346027,"visible":true,"origin":"","legend":"\u003cp\u003eProbability density analyses before and after PSM\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4834515/v1/e1d1730ad635434c8adcb4ab.jpg"},{"id":64009014,"identity":"ef7a5364-e5c1-44d7-bc0a-a5dedc5da74c","added_by":"auto","created_at":"2024-09-04 23:10:50","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":357706,"visible":true,"origin":"","legend":"\u003cp\u003eSMD analysis of the PSM model\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4834515/v1/f33697eb7e846bf363b3af6c.jpg"},{"id":68042065,"identity":"1c8c1691-40e7-4919-bb60-f241ac63be8a","added_by":"auto","created_at":"2024-11-01 16:46:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2640390,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4834515/v1/8176bb68-eb88-4639-9388-a4eca7a30a79.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Are Novice Resident Physicians Capable of Executing Freehand Cognitive Fusion Transperineal Prostate Biopsies ?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eProstate Cancer (PCa) is the second most commonly diagnosed cancer worldwide in 2022, also ranking as the fifth leading cause of cancer-related deaths in men [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Prostate-specific antigen (PSA) screening has significantly improved the early diagnosis rate of PCa, leading to a gradual decrease in mortality rates [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Despite the introduction of various new diagnostic tools and biomarkers that enhance the accuracy of early PCa detection, prostate biopsy remains the primary method for definitive diagnosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While MRI-guided targeted biopsy offers higher accuracy and lower complication rates, its high hardware requirements have hindered widespread adoption, making ultrasound-guided prostate biopsy the predominant approach. Studies indicate that although transrectal prostate biopsy covers a wider range [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], the detection rates between transrectal and transperineal biopsies are comparable, with the latter associated with a lower risk of infection [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It has thus become a trend to shift from transrectal to transperineal biopsies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In prostate biopsy, the two main auxiliary targeting methods are cognitive fusion biopsy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]and image fusion biopsy [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], with the former being more widely used in clinical practice due to its lack of specific hardware requirements. While some centers use template-guided biopsies [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], free-hand cognitive fusion transperineal prostate biopsy (fTP-Bx) is more common [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This is mainly because fTP-Bx has lower hardware requirements and its complication rate and detection rate for clinically significant prostate cancer (csPCa) are not significantly inferior to other biopsy methods [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe operator\u0026rsquo;s experience is a crucial factor influencing the effectiveness of various medical procedures [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Previous studies have shown that the results of MR-guided targeted biopsy of the prostate performed by the same operator are closely related to the biopsy experience. With the accumulation of biopsy experience, the accuracy of the biopsy improves, and the operation time is significantly reduced [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Through the summary of experiences in transperineal prostate biopsy, it was found that native residents can achieve a high PCa detection rate after brief training [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It is foreseeable that with the increase of biopsy experience, the detection rate of small tumors will gradually increase for the same physician [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In addition, studies indicate that during local anesthesia prostate biopsy, novice physicians exacerbate the pain level for patients compared to experienced physicians [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Although there is no significant correlation between the detection rate of csPCa and the experience of the operating surgeon during robot-assisted prostate biopsy [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], for fTP-Bx, there is still a need for further research on whether there is a significant difference in the detection rate of csPCa among operators with different biopsy experiences, especially among the group of operators primarily responsible for fTP-Bx (including novice and experienced resident physicians). This issue is significant enough to affect patient education on prostate biopsy and clinical practice.\u003c/p\u003e \u003cp\u003eTo address the above clinical question, this study collected clinical data related to 398 cases of fTP-Bx conducted in our hospital and, through the use of propensity score matching (PSM), compared the absolute number of cores involved, percentage of cores involved, csPCa detection rates, and overall PCa detection rates between the different prostate biopsy experience groups.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eA total of 398 patients who underwent fTP-Bx in the Department of Urology at the Affiliated Hospital of Qingdao University from March 1, 2023, to March 1, 2024, were included in the study. They were divided into two groups: the Experienced Group and the Novice Group. The Novice Group consisted of two residents with less than 10 cases of experience in prostate biopsy, while the Experienced Group consisted of two residents with over 100 cases of experience in prostate biopsy. The Experienced Group had 196 patients, and the Novice Group had 202 patients. This study was approved by the Medical Ethics Committee of the Affiliated Hospital of Qingdao University, with approval number QYFY WZLL 28966.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStrategy of fTP-Bx\u003c/h2\u003e \u003cp\u003eDue to the higher detection rate of csPCa with the combination of target and systematic cores [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], all patients underwent free-hand transperineal targeted biopsy and additionally a transperineal systematic biopsy [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Anesthesia options included local anesthesia and general anesthesia, with the decision jointly made by the patient, surgeon, and anesthesiologist.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Data and Evaluation Indicators\u003c/h2\u003e \u003cp\u003eCollect preoperative information of patients: age, body mass index (BMI), prostatic acid phosphatase (PAP), total prostate-specific antigen (TPSA), PSA density (PSAD), prostate volume, prostate anteroposterior diameters, prostate transverse diameters, prostate axial diameters, Prostate Imaging-Reporting and Data System (PI-RADS), operation time, and anesthesia method. Postoperative pathological specimens were evaluated by two senior pathologists. The mpMRI includes T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences. Pathological results include total number of cores, the absolute number of cores involved, percentage of cores involved (absolute number of cores involved / total number of cores), percentage of one needle PCa, csPCa (Gleason score\u0026thinsp;\u0026ge;\u0026thinsp;3\u0026thinsp;+\u0026thinsp;4\u0026thinsp;=\u0026thinsp;7) detection rates, and overall PCa detection rates and World Health Organization / International Society of Urological Pathology (WHO/ISUP) classification.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Methods\u003c/h2\u003e \u003cp\u003eStatistical analysis was conducted using SPSS 25.0 software. PSM was used to match the two groups of patients. Initially, covariates such as age, BMI, PAP, anteroposterior diameters, transverse\u003c/p\u003e \u003cp\u003ediameters, axial diameters, prostate volume, TPSA, PSAD, PI-RADS, operation time, anesthesia type, etc., were used as matching factors, and logistic regression analysis was employed to estimate the propensity score. Subsequently, nearest neighbor matching method and caliper value rule of 0.25 were used for 1:1 case matching. After matching, continuous data following normal distribution were expressed as Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD and compared between groups using t-test; while data following skewed distribution were expressed as Median (1st Quartile, 3st Quartile) and compared between groups using Mann-Whitney test. Count data results were presented as n (%) and analyzed using χ2 test or Fisher\u0026rsquo;s exact test. All statistical analyses were two-tailed tests, and a \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eClinical Characteristics of Patients in Different Groups\u003c/h2\u003e \u003cp\u003eThe clinical characteristics of patients in different groups are described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Before PSM, the Experienced Group and Novice Group enrolled 196 and 202 patients, respectively. Among all covariates, surgical time and mpMRI scores showed statistical differences. The Novice Group had a longer average surgical time (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.014). In terms of mpMRI scoring, the two groups of patients demonstrated different distribution trends. A higher proportion of patients with high PI-RADS (\u0026ge;\u0026thinsp;4) was observed in the Experienced Group, while more patients in the Novice Group had PI-RADS\u0026thinsp;\u0026lt;\u0026thinsp;4 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009). After PSM, all covariates between the two groups showed no statistical differences (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Probability density analyses before and after PSM demonstrated a good matching effect (Fig.\u0026nbsp;1). Standard Mean Difference (SMD) analysis showed that covariates represented by TPSA had higher SMD values, whereas after PSM, the SMD values of all covariates were controlled below 0.2 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics of the entire cohort\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eBefore PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExperienced Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;196)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNovice Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;202)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSMD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eExperienced Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNovice Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSMD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.51\u0026thinsp;\u0026plusmn;\u0026thinsp;7.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.48\u0026thinsp;\u0026plusmn;\u0026thinsp;7.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.167 \u003csup\u003et\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e68.64\u0026thinsp;\u0026plusmn;\u0026thinsp;7.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e68.50\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.876 \u003csup\u003et\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.99\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.52\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.101 \u003csup\u003et\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24.09\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.200 \u003csup\u003et\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnteroposterior diameters, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.874 \u003csup\u003et\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.739 \u003csup\u003et\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransverse diameters, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.905 \u003csup\u003et\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.906 \u003csup\u003et\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAxial diameters, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.856 \u003csup\u003et\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.873 \u003csup\u003et\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time, M (Q₁, Q₃)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.00 (15.00, 25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.00 (15.00, 25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e \u003csup\u003e\u003cb\u003eU\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.00 (15.00, 25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20.00 (15.00, 25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.272 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTPSA, M (Q₁, Q₃)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.31 (6.56, 27.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.74 (6.95, 19.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.615 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.68 (6.26, 17.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.16 (6.93, 21.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.255 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProstate volume, M (Q₁, Q₃)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.49 (38.18, 73.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.97 (38.44, 75.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.910 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e54.12 (37.37, 71.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e55.81 (35.68, 76.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.800 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAD, M (Q₁, Q₃)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.18 (0.12, 0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.20 (0.12, 0.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.945 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.18 (0.12, 0.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.20 (0.12, 0.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.240 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesia, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.230 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.340 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocal anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (29.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (24.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e39 (26.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e32 (21.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-0.116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138 (70.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153 (75.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e107 (73.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e114 (78.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003empMRI, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e \u003csup\u003e\u003cb\u003eC\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.399 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePI-RADS\u0026thinsp;\u0026le;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (35.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (40.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e57 (39.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e55 (37.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePI-RADS\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (27.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (37.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e47 (32.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e57 (39.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePI-RADS\u0026thinsp;\u0026ge;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (36.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (22.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42 (28.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e34 (23.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-0.130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eSD: standard deviation, M: Median, Q₁: 1st Quartile, Q₃: 3st Quartile\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csup\u003et\u003c/sup\u003e t-test; \u003csup\u003eU\u003c/sup\u003e Mann-Whitney test;\u003csup\u003eC\u003c/sup\u003e Chi-square test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInter-group comparison of PCa detection rate.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWe used six parameters respectively to fully evaluate the differences in the efficacy of prostate biopsies between two groups. The results showed that there were no significant differences between operators with different levels of experience in terms of the detection rates of PCa or csPCa, the malignancy of the detected tumors, or the rate of one needle PCa(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the diagnostic efficacy of PCa between two groups of surgeons\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBefore PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExperienced Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;196)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNovice Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;202)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExperienced Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNovice Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsolute number of cores involved, M (Q₁, Q₃)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.00 (3.00, 11.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.00 (4.00, 11.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.746 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.50 (3.25, 9.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.00 (4.00, 11.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.416 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePercentage of cores involved, M (Q₁, Q₃)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.57 (0.23, 0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.57 (0.29, 0.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.616 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.50 (0.23, 0.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.59 (0.29, 0.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.538 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne needle PCa, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.692 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.709 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87 (91.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80 (89.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53 (91.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e59 (89.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (8.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (10.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5 (8.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7 (10.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCa, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.378 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.344 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101 (51.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113 (55.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e88 (60.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e80 (54.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95 (48.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (44.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e58 (39.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e66 (45.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecsPCa, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.926 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (2.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (3.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1 (1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88 (97.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80 (97.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52 (96.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e59 (98.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWHO/ISUP classification, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.107 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.95 \u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (27.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (40.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20 (35.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25 (37.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e=\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (29.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (30.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18 (31.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20 (30.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (42.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (29.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19 (33.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e21 (31.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eSD: standard deviation, M: Median, Q₁: 1st Quartile, Q₃: 3st Quartile\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003et\u003c/sup\u003e t-test; \u003csup\u003eU\u003c/sup\u003e Mann-Whitney test;\u003csup\u003eC\u003c/sup\u003e Chi-square test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThere are many factors that influence the results of prostate biopsy, so excluding a large number of confounding factors is necessary when comparing the biopsy effects of different operators. PSM is a better analytical strategy used in clinical research to control confounding factors [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This study used PSM to balance the confounding factors in the baseline information and evaluated the differences in biopsy results between different groups. Among the confounding factors included in this study, TPSA, PSAD, prostate volume, and PI-RADS have been proven to affect the positive rate of prostate biopsy [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. There were inter-group differences in the baseline mpMRI PI-RADS scores of the two groups, which were calibrated by PSM. Age progression is a clear risk factor for PCa and has been included as a confounding factor for balance [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. There is also some research evidence regarding the correlation between BMI and PCa, for example, BMI can increase the risk of developing PCa [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and overweight and obese PCa patients have a higher risk of lymph node metastasis compared to PCa patients with normal BMI [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], so this study also includes BMI as a balancing factor. The reason for including PAP as a confounding factor is that as a nonspecific alkaline phosphatase synthesized in prostate epithelial cells, PAP levels increase proportionally with the progression of PCa [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and recent studies have reported that the plasmid DNA vaccine encoding PAP (pTVG-HP) has made some progress in treating metastatic castration-resistant PCa patients [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. There is currently no research exploring the effects of the anteroposterior diameters, transverse diameters, and axial diameters of the prostate on the positive rate of prostate biopsy. This study found differences in the detection rate of PCa based on three-dimensional diameters in a small sample pre-experiment, but unfortunately, this significant difference disappeared after including all study samples. Whether transrectal or transperineal, the same operator can significantly shorten the operation time with the accumulation of surgical experience [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Similarly, this study also found that the Novice Group had a longer operation time, and the length of the operation time may be influenced by the distribution and size of the lesion, so matching the operation time eliminated this confounding factor. As mentioned above, the choice of anesthesia is decided jointly by the patient, the operator, and the anesthesiologist. It has been found in a study that performing a transperineal prostate biopsy under local anesthesia can cause moderate pain, but the pain does not affect the detection rate of csPCa [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Nonetheless, this study still includes the type of anesthesia as one of the matching factors.\u003c/p\u003e \u003cp\u003eDespite the gradual stabilization of tumor detection rates with the accumulation of puncture experience by the same operator [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], whether there is necessarily a significant difference between operators with different levels of experience has not been fully confirmed by research. Novice resident physicians and Experienced resident physicians are the main workforce responsible for fTP-Bx in various urology centers, so this study specifically explored these two groups. The study found that before PSM, the puncture positive rates of the Experienced Group and the Novice Group were 48.47% and 44.06%, respectively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.378). After PSM, there was still no significant difference in the puncture positive rates between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.344), and similarly, there was no inter-group difference in csPCa detection rate. Upon further refinement of the indicators, the percentage of cores involved in both groups was also evenly comparable. The One needle PCa detection rate was included to assess puncture accuracy under extreme conditions, and the results showed that the rates in both groups were between 8\u0026ndash;10% with no inter-group differences. Finally, among the detected PCa cases, the proportions of patients with different WHO/ISUP classifications were similar. These results fully confirm that the cancer detection efficacy of Novice resident physicians performing fTP-Bx is comparable to that of Experienced resident physicians. When communicating with patients and their families, it can confidently be stated that the efficacy of Novice resident physicians in performing fTP-Bx is reliable.\u003c/p\u003e \u003cp\u003eThis study has certain limitations. Firstly, the study did not delve into the learning curve of fTP-Bx. Some studies have shown that after transperineal prostate biopsy, 12 cases reached the learning improvement stage, and 80 cases reached the proficiency stage. This study lacks exploration of the thresholds related to the effectiveness of biopsy by different operators. Secondly, the diameter of the lesion can affect the positive rate of prostate biopsy, and our study did not include this factor for matching because the original report did not contain relevant data. Re-measuring during the study process would introduce new bias [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Lastly, the study did not explore the inter-group differences in biopsy complications, mainly including pain and infection. Because this study is retrospective, there was a delay in collecting indicators such as pain, which could introduce recall bias. Additionally, all patients in this center received prophylactic levofloxacin before surgery, and patients left the hospital within 24 hours after completing the biopsy. Therefore, the original data did not contain detailed infection-related indicators [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eNovice resident physicians using fTP-Bx show no difference in detecting PCa compared to experienced resident physicians, indicating that novice resident physicians are capable of executing fTP-Bx work well.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePCa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eprostate Cancer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePSA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eprostate-specific antigen\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003efTP-Bx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003efree-hand cognitive fusion transperineal prostate biopsy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ecsPCa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eclinically significant prostate cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePSM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003epropensity score matching\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ebody mass index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePAP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eprostatic acid phosphatase\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eTPSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003etotal prostate-specific antigen\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePSAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePSA density\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePI-RADS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eProstate Imaging-Reporting and Data System\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eWHO/ISUP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eWorld Health Organization / International Society of Urological Pathology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eSMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eStandard Mean Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYize Guo and Bin Li conceived the study design, and Yanjiang Li and Wei Zhang supervised the project. Yongchao Yan and Xuemei Ding helped collect the clinical information of patients who underwent fTP-Bx in the Department of Urology. Yize Guo and Bin Li performed the analysis of the results. Yize Guo edited the first manuscript, and Yanjiang Li and Wei Zhang revised it. Finally, all the authors reviewed this article. The authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded by the Youth Research Fund of Qingdao University Affiliated Hospital (QDFYQN2023119).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part are appropriately investigated and resolved. This study was performed in accordance with the principles of the Declaration of Helsinki. The research protocol of this study was approved by the Ethics Committee of the Affiliated Hospital of Qingdao University (Approval No. QYFY WZLL 28966, approval date: 26 July 2024). The informed consent requirement for this study was waived with the approval of the Ethics Committee of the Affiliated Hospital of Qingdao University because the study was conducted retrospectively and the opportunity to refuse was guaranteed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A: \u003cstrong\u003eGlobal cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries\u003c/strong\u003e. \u003cem\u003eCA: a cancer journal for clinicians \u003c/em\u003e2024, \u003cstrong\u003e74\u003c/strong\u003e(3):229-263.\u003c/li\u003e\n\u003cli\u003eCenter MM, Jemal A, Lortet-Tieulent J, Ward E, Ferlay J, Brawley O, Bray F: \u003cstrong\u003eInternational variation in prostate cancer incidence and mortality rates\u003c/strong\u003e. \u003cem\u003eEuropean urology \u003c/em\u003e2012, \u003cstrong\u003e61\u003c/strong\u003e(6):1079-1092.\u003c/li\u003e\n\u003cli\u003eKv\u0026aring;le R, Auvinen A, Adami HO, Klint A, Hernes E, M\u0026oslash;ller B, Pukkala E, Storm HH, Tryggvadottir L, Tretli S\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eInterpreting trends in prostate cancer incidence and mortality in the five Nordic countries\u003c/strong\u003e. \u003cem\u003eJournal of the National Cancer Institute \u003c/em\u003e2007, \u003cstrong\u003e99\u003c/strong\u003e(24):1881-1887.\u003c/li\u003e\n\u003cli\u003eSchafer EJ, Jemal A, Wiese D, Sung H, Kratzer TB, Islami F, Dahut WL, Knudsen KE: \u003cstrong\u003eDisparities and Trends in Genitourinary Cancer Incidence and Mortality in the USA\u003c/strong\u003e. \u003cem\u003eEuropean urology \u003c/em\u003e2023, \u003cstrong\u003e84\u003c/strong\u003e(1):117-126.\u003c/li\u003e\n\u003cli\u003eMottet N, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, Fanti S, Fossati N, Gandaglia G, Gillessen S\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eEAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. 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\u003cstrong\u003e205\u003c/strong\u003e(3):653-663.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Prostate cancer, Free-hand cognitive fusion transperineal prostate biopsy, Propensity score matching, Clinically significant prostate cancer","lastPublishedDoi":"10.21203/rs.3.rs-4834515/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4834515/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe study aimed to evaluate the differences in prostate cancer (PCa) detection rates between novice and experienced resident physicians using free-hand cognitive fusion transperineal prostate biopsy (fTP-Bx) through propensity score matching (PSM).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on a cohort of patients who underwent fTP-Bx procedures. The needle biopsies were performed by two groups of surgical doctors with varying levels of prostate biopsy experience (Novice Group and Experienced Group) between March 1, 2023, and March 1, 2024. The PSM method was employed to compare the differences in cancer detection-related parameters between various groups of differing prostate biopsy experience levels.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn total, 398 patients were included in the study, with 196 in the Experienced Group and 202 in the Novice Group. Prior to PSM, significant differences were observed between the groups in terms of operation duration (p\u0026thinsp;=\u0026thinsp;0.014) and multiparametric MRI results (mpMRI, p\u0026thinsp;=\u0026thinsp;0.009). However, after adjusting for confounding factors through PSM, there were no differences in the absolute number of cores involved, percentage of cores involved, clinically significant prostate cancer (csPCa) detection rates, and overall PCa detection rates between the different prostate biopsy experience groups. Despite potential variations in operation duration related to different levels of needle biopsy experience, there were no distinctions observed between novice and experienced doctors in terms of prostate cancer detection, particularly concerning csPCa.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eNovice resident physicians have the ability to complete qualified fTP-Bx.\u003c/p\u003e","manuscriptTitle":"Are Novice Resident Physicians Capable of Executing Freehand Cognitive Fusion Transperineal Prostate Biopsies ?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-04 23:10:45","doi":"10.21203/rs.3.rs-4834515/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"032b5088-72b1-46e0-a419-41464d990678","owner":[],"postedDate":"September 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-01T16:38:45+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-04 23:10:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4834515","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4834515","identity":"rs-4834515","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}