TRANSPERINEAL (TP) biopsy has, until now, been widely accepted as the preferred method for prostate biopsy, compared to transrectal (TR) biopsy.
In one of the so-called game-changing sessions in this year’s European Association of Urology (EAU) Congress in Paris, France, Badar Mian, Albany Medical College, New York, USA, presented the results of the ProBE-PC randomised clinical trial. As the first randomised trial in this field, the ProBE-PC trial set out to determine the efficacy of TR versus TP prostate biopsy in detecting clinically significant prostate cancer (csPCa), infectious complications, and toxicity. The trial used the URONAL fusion platform for both TR and TP biopsy procedures, and included 840 males undergoing initial or repeat prostate biopsy, with or without multiparametric-MRI lesions. Patients for whom there was no access to the rectum were excluded from the study. Out of all patients, 96% had a pre-biopsy MRI.
Results demonstrated no difference in the rates of detection for csPCa (47.1% detection rate for TR biopsy versus 43.2% for TP biopsy), or for all cancer detection rates (72.1 % for TR versus 70.4% for TP). Neither of these biopsy approaches was found to be a predictor of csPCa, whereas prostate specific antigen density, digital rectal exam, and multiparametric-MRI results were found to be predictors of csPCa.
In subgroups of males who had MRI-targeted biopsy, TR biopsy demonstrated a 56% detection rate of high-grade prostate cancer, versus 53% for TP biopsy. In males with anterior lesions on MRI, TR biopsy demonstrated a 42% detection rate compared to 39% in TP biopsy. The initial, recently published results from this trial demonstrated no difference in infectious complications between the two methods.1
Although this is a single-site study performed by a limited number of urologists, its pragmatic design means that it is very much representative of routine clinical practice.
Commenting on these findings, Brian Chapin, MD Anderson Cancer Center, Houston, Texas, USA, explained that neither TP or TR biopsy is more sensitive at detecting csPCa when using a systematic approach in males who were either biopsy-naïve or had a targeted biopsy. However, Chapin believes TP biopsy is the preferred approach based on antibiotic stewardship, but TR biopsy is reasonable with targeted prophylaxis. As both are not without complications, both groups should be consulted on the risks. Results from TRANSLATE, a larger, multicentre, randomised controlled trial, are awaited later this year, and are expected to shed further light and help in decision-making in this area.
Reference
- Mian BM et al. Complications following transrectal and transperineal prostate biopsy: results of the ProBE-PC randomized clinical trial. J Urol. 2024;211(2):205-13
