为了评估风险计算器（RCs）在接受经会阴经直肠MRI / TRUS融合模板饱和活检（TTSB）和传统系统经直肠经直肠超声引导活检（SB）的男性中预测淋巴结侵袭（LNI）和前列腺外扩展（EPE）的性能。RCs在2005年至2019年期间进行了一项连续队列研究，包括645名接受根治性前列腺切除术并进行广泛盆腔淋巴结清扫的男性。其中有230（35.7％）男性进行了TTSB，415（64.3％）男性进行了SB。使用现有的RCs计算了LNI和EPE的风险。根据不同的活检技术对鉴别度、校准度和临床效用进行了评估。TTSB中观察到23例（10％）LNI和73例（31.8％）EPE的病例，SB中观察到53例（12.8％）LNI和158例（38％）EPE。RCs在预测TTSB中的LNI方面表现出优秀的鉴别能力和可接受的校准度（MSKCC-RC：AUC / 风险估计0.79 / -4％；Briganti（2012）-RC：AUC / 风险估计0.82 / -4％；Gandaglia-RC：AUC / 风险估计0.81 / +6％）。在SB中的表现与之类似（MSKCC-RC：AUC / 风险估计0.78 / +2％；Briganti（2012）-RC：AUC / 风险估计0.77 / -3％）。决策曲线分析（DCA）显示，在使用TTSB时在阈值概率3-6％之间出现了净益。基于TTSB预测EPE时观察到较差的鉴别能力和变化的校准度（MSKCC 0.71 / +8％；Martini-RCs 0.69 / +2％），只有在风险阈值超过17％时在DCA上出现净益。基于SB的LNI和EPE的RCs的性能显示出类似的结果，LNI的DCA表现更好（风险阈值1-2％），而EPE表现较差（风险阈值>20％）。本研究的局限性在于其回顾性的单一机构设计。TTSB的潜在更准确的分级能力并没有导致术前RCs的性能改善。LNI的预测工具证明了临床效用，而EPE的RCs则没有。本文受版权保护，所有权利保留。

To evaluate the performance of risk calculators (RCs) predicting lymph node invasion (LNI) and extraprostatic extension (EPE) in men undergoing transperineal MRI/TRUS-fusion template saturation biopsy (TTSB) and conventional systematic transrectal TRUS-guided biopsy (SB).RCs were tested in a consecutive cohort of 645 men undergoing radical prostatectomy with extended pelvic lymph node dissection between 2005 and 2019. TTSB was performed in 230 (35.7%) and SB in 415 (64.3%) men. Risk for LNI and EPE was calculated using available RCs. Discrimination, calibration and clinical usefulness stratified by different biopsy techniques were assessed.LNI was observed in 23 (10%) and EPE in 73 (31.8%) of cases with TTSB and 53 (12.8%) and 158 (38%) with SB, respectively. RCs showed an excellent discrimination and acceptable calibration for prediction of LNI based on TTSB (AUC/risk estimation: MSKCC-RC 0.79/-4%, Briganti(2012)-RC 0.82/-4%, Gandaglia-RC 0.81/+6%). These were comparable in SB (MSKCC-RC 0.78/+2%; Briganti(2012)-RC 0.77/-3%). Decision curve analysis (DCA) revealed a net benefit at threshold probabilities between 3-6% when TTSB was used. For prediction of EPE based on TTSB an inferior discrimination and variable calibration were observed (AUC/risk estimation: MSKCC 0.71/+8%, Martini-RCs 0.69/+2%) achieving a net benefit on DCA only at risk-thresholds above 17%. Performance of RCs for prediction of LNI and EPE based on SB showed comparable results with a better performance in the DCA for LNI (risk thresholds 1-2%) and poorer performance for EPE (risk threshold >20%). This study is limited by its retrospective single-institution design.The potentially more accurate grading ability of TTSB did not result in improved performance of preoperative RCs. Prediction tools for LNI proved clinical usefulness while RCs for EPE did not.This article is protected by copyright. All rights reserved.