Reply to Editorial Comments: The Number of Cancer-Involved Regions in Patients With Prostate Cancer Diagnosed by Magnetic Resonance Imaging/Ultrasound-Guided Fusion Prostate Biopsy Is a New Tumor Metric Associated With the Increased Risk of Adverse Pathology at Radical Prostatectomy

We sincerely thank Drs. Cosenza and Jacobs1 for their thoughtful editorial comment and for placing our findings within the broader context of contemporary prostate cancer risk stratification. We appreciate the recognition of the potential clinical relevance of biopsy-derived tumor burden metrics, particularly number of cancer-involved regions (NCIR) and maximum cancer core length (MCCL), in improving preoperative assessment.2 We agree that operator expertise, variability in MRI-fusion biopsy techniques, and differences in histopathological interpretation represent important sources of heterogeneity. Our single-center design and predefined biopsy strategy were intended to minimize such variability; however, we acknowledge that these factors remain relevant and should be addressed in future multicenter studies. We also agree that integration of advanced imaging, including mpMRI-derived and PSMA-PET–derived parameters, may further refine risk stratification and enhance the biological interpretation of tumor burden metrics. These approaches, together with a number of cancer-involved regions and maximum cancer core length, may contribute to more individualized treatment decision-making. We appreciate the opportunity to position our findings within the evolving landscape of prostate cancer risk assessment and thank the authors for their insightful perspective and constructive discussion.