Role of Systematic Biopsy in the Era of Targeted Biopsy: A Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

I have read the manuscript titled "Role of systematic biopsy in the era of targeted biopsy. A Review." The authors provided a detailed review of systematic biopsy. The manuscript is scientific sound and rather comprehensive. I believe the topic discussed has clinical potential and therefore should be considered publishing. I have only one concern about the visual presentation. However, I have one concern regarding the visual presentation. Currently, the manuscript lacks figures and tables, which could enhance its readability. I recommend that the authors consider including some figures or tables to improve the overall clarity and accessibility of the content.

Author Response

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Reviewer 2 Report

Comments and Suggestions for Authors

This work is a well-written review paper that covers important aspects of prostate cancer diagnosis, specifically the distinctions between insignificant and clinically significant prostate cancer using targeted biopsy. It also addresses integration strategies by combining systematic and targeted biopsy data. The paper includes citations to recent guidelines and trials. Due to the importance of the reviewed subjects, I would like to recommend this work for publication.

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Summary

The article is a comprehensive white paper on a very actual topic of prostate biopsy. It describes the position, effectivity and adverse effects of currently employed methods o prostate biopsy. Numerous trials, meta-analyses and retrospective analyses are summarized and conclusions are derived. This review may be influential in a period of currently growing demand for diagnostics within a development of potentially controversial screening for prostate cancer. The review is pretty comprehensive and presents only well documented and reproducible information. It may be very helpful in diagnostic strategy decision making.   

 

General concept

The concept of presentation maintains systematic well arranged information transfer. The efficacy of each method and adverse effects of each method is presented first then comparison of various methods - comparative analysis - follows, finally a kind of recommendation for use in routine is drawn.  There is a good level of evidence for each statement supported by recent influential publications.  

This concept fits well to the purpose of this white paper. There is no hypothesis presented, only pure data with particular evidence. 

 

 

Review, specific comments

The structure of the article is relevant and logical. There is a huge body of information for each method of biopsy resulting in rather long paragraphs. Some information overlaps from one paragraph to other ones. It slightly complicates easy survey and orientation in the text.  E.g.: Section 4 presents targeted biopsy techniques, i.e. mainly MRI targeted biopsies (section 4.1).  Fusion targeted biopsy is presented separately in section 5. This section is seemingly dedicated to fusion biopsy only; however, it contains also section 5.1. In-bore biopsy.  The structure of section 5 is not fully logical.

 

There is a plenty of abbreviations in the text, naturally there is no other option. It is recommendable to present a list of abbreviations explaining each in alphabetical order. Each abbreviation is duly explained after first use, however some escaped. E.g. “SB”. Despite its sense is logically clear it deserves explaining statement.   Anyway, the abbreviations must be used very frequently and there is indeed a plenty of them, thus the list might be helpful for the reader.

 

Various methods of biopsy are described, the principal of some of them may be difficult to understand for some non-urologist, non-oncologist reader.  It is advisable to present some illustration elucidating principal of some methods, e.g. fusion biopsy.  It may also be beneficial to elucidate the reasons for different efficacy of transrectal vers. transperineal approach by means of illustration.

 

The information on comparison of systematic biopsy vers. targeted biopsies (section 6) is very valuable. However, the orientation in the section may not be easy. Thus, it is recommendable to present the results of trials in a form of tables.  It would make the survey much more readable and understandable.   Moreover, if such influential results are presented.

 

The conclusion is plausible and gives insight into the discussed problem and indicates some assumption for potential screening programme.

 

The whole text strictly concerns the topic, there is no abundant information or statement.

All statements are supported by a huge body of literature, 182 citations are presented, including also rare older than 10 years, anyway each containing decisive data relevant to the topic.

 

There are no ethic aspects for this white paper.

 

Conclusion

Very important and highly informative white paper.  It may be helpful to establish strategy of diagnostic wide practice as well as strategy of screening, should any screening be developed.

The article may be informative for a wide range of readers of various specializations besides urology and oncology.  

The article is recommended to be accepted after minor revisions. 

Author Response

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Author Response File: Author Response.pdf