## 3 Results  
### Comparison of Diagnostic Values of Targeted and Systematic Prostate Biopsies  
In total, 283 patients have been included in the study (17 cases were excluded due to the clinical and anatomical reasons; data of these cases are not shown). Clinical and radiological characteristics of the study cohort are provided in Table 1.  
The overall detection rate of PCa in the cohort was 80.21% (227/283), while targeted MRI/US-guided biopsy and adapted systematic biopsy detected PCa in 74.56% (211/283) and 48.76% (138/283) of patients (\(p\) < 0.001), respectively. The clinically significant disease was detected in 34.28% (97/283) of patients undergoing prostate biopsy. The detection rate of clinically significant disease by targeted MRI/US-guided biopsy was 34.28% (97/283), which accounted for 45.97% (97/211) of all PCa diagnoses. Meanwhile, the detection rate of clinically significant disease after AdSB was significantly lower (8.48%; 24/283; \(p\) < 0.001), which accounted just for a small number 17.39%; 24/138) of all PCa cases in comparison to targeted methodology only (17.39% vs. 45.97%; \(p\) < 0.001 Figure 1). Among patients with clinically significant PCa detected by targeted prostate biopsy (\(n\) = 97), AdSB reconfirmed clinically significant PCa diagnosis just for 24.74% (\(n\) = 24) of patients. In patients for whom no clinically significant PCa was detected by targeted biopsy, also, no clinically significant cancer was detected by AdSB. AdSB identified 16 additional cases of clinically insignificant PCa for patients with no signs of cancer on targeted prostate biopsy. \begin{table}
\begin{tabular}{c c c} \hline \hline
**Variable** & \multicolumn{2}{c}{**Patients (\(n\) = 283)**} \\ \hline Age, years & Mean & 63.59 \\  & SD & 7.41 \\ \hline PSA, ng/mL & Mean & 7.67 \\  & SD & 5.89 \\ \hline PSA density, ng/mL/cc & Mean & 0.19 \\  & SD & 0.49 \\ \hline Prostate volume, mL & Mean & 50.84 \\  & SD & 23.18 \\ \hline mpMRI targets quantity, \(n\) & Mean & 1.51 \\  & SD & 0.65 \\ \hline mpMRI target volume, mL & Mean & 1.21 \\  & SD & 1.96 \\ \hline mpMRI ADC value \(\mu\)m\({}^{2}\)/s & Mean & 634.56 \\  & SD & 204.85 \\ \hline PI-RADS V2.1 score, \(n\) (%) & 3 & 11 (3.9\%) \\  & 4 & 190 (67.1\%) \\  & 5 & 82 (29.0\%) \\ \hline ISUP grade group, \(n\) (%) & No PCa & 56 (19.8\%) \\  & GG1 & 130 (45.9\%) \\  & GG2 & 62 (21.9\%) \\  & GG3 & 28 (9.9\%) \\  & GG4 & 7 (2.5\%) \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Clinical and radiological characteristics of the study cohort. PSA—prostate-specific antigen, mpMRI—multi-parametric magnetic resonance imaging, ADC—apparent diffusion coefficient, ISUP—The International Society of Urological Pathology, GG—prostate cancer grade group. Based on the PI-RADS v2.1 system, the detection rate of clinically significant disease after the targeted prostate biopsy was dependent on PI-RADS's group and was predominant among cases with PI-RADS 5 (PI-RADS 3 vs. PI-RADS 4 vs. PI-RADS 5, while \(p<0.001\); Figure 2). Meanwhile, the results of AdSB showed no associations with PI-RADS scores of mpMRI (PI-RADS-3 0.00% vs. PI-RADS-4 7.92% vs. PI-RADS-5 11.00%, \(p=0.415\)). ISUP grade group score was also predominantly higher in the PI-RADS 5 group as compared to PI-RADS 4 and PIRADS 3 groups, and the results are shown in Table 2.  
Figure 1: The comparison of diagnostic value of targeted and systematic prostate biopsy (\(n=283\)). AdPB—12-core systematic biopsy ignoring index lesions, mpMRI/US fusion targeted prostate biopsy. Figure 2: Concordance between PI-RADS v2.1 category and histology after targeted biopsy. Note—statistically significant association between the proportion of clinically significant lesions (Gleason 3+4 or higher) for each category of PI-RADS v2.1 (\(p<0.001\), \(n=283\)). Using the same approach, the sensitivity and specificity of AdSB group were 8.52% and 92.31%, respectively, with a Youden-selected cut-off value of PI-RADS v2.1 \(\geq\) 4 (AUC = 0.504; 95% CI: 0.6-0.7 Figure 3).