Comparison of Transrectal and Transperineal Prostate Fusion Biopsy Approaches
Overview
This matched analysis of 1292 patients compared transrectal (TR) and transperineal (TP) MRI-targeted and systematic prostate biopsies. The TP approach demonstrated a significantly higher detection rate of clinically significant prostate cancer (csPCa) without increased complications compared to the TR approach.
Background
Prostate biopsy techniques have shifted from transrectal to transperineal routes due to concerns about infectious complications and improved detection of clinically significant prostate cancer, especially in anterior and apical regions. European guidelines recommend TP biopsies for systematic sampling, while American guidelines allow either approach. Despite this, both techniques remain in use, and comparative data from large multicenter cohorts are limited. This study aimed to evaluate diagnostic accuracy and complication rates of TP versus TR fusion biopsies in routine clinical practice.
TP biopsy detected significantly more clinically significant prostate cancer (50.5%) than TR biopsy (36.2%) overall (p < 0.001).
Targeted cores from TP biopsies had higher detection rates of csPCa (44.0% vs 30.5%, p < 0.001) and any PCa (60.4% vs 54.6%, p = 0.04).
Systematic biopsy cores showed higher overall PCa detection with TR approach (59.4% vs 43.5%, p < 0.001), but no difference in csPCa detection.
Complication rates including infections (0.3% TP vs 0.8% TR) and acute urinary retention were low and not significantly different between groups.
TP biopsies sampled more anterior lesions (37.1% vs 25.8%) and had more patients with prior negative biopsy (18.9% vs 2.2%).
TP approach showed higher csPCa detection in anterior and posterior lesions, and at apical and equatorial prostate regions.
Clinical Implications
The transperineal approach offers superior detection of clinically significant prostate cancer, particularly in anterior and apical regions, without increasing complication rates compared to the transrectal route. Clinicians should consider TP biopsy especially in patients with prior negative biopsies or lesions in challenging locations. Both approaches remain safe, but TP may provide enhanced diagnostic accuracy in routine practice.
Conclusion
In this large matched cohort, transperineal prostate fusion biopsy demonstrated higher clinically significant cancer detection than transrectal biopsy with comparable safety profiles. These findings support the preferential use of the transperineal approach in clinical practice.
by Marco Oderda, Romain Diamand, Rawad Abou Zahr, Julien Anract, Gregoire Assenmacher, Nicolas Barry Delongchamps, Alexandre Patrick Bui, Daniel Benamran, Giorgio Calleris, Charles Dariane, Mariaconsiglia Ferriero, Gaelle Fiard, Fayek Taha, Alexandre Fourcade, Georges Fournier, Karsten Guenzel, Adam Halinski, Giancarlo Marra, Guillaume Ploussard, Katerina Rysankova, Jean-Baptiste Roche, Giuseppe Simone, Olivier Windisch, Paolo Gontero
