TRANSPERINEAL (TP) prostate biopsy is a promising alternative to the traditional transrectal (TR) biopsy for prostate cancer (PCa) diagnosis. As PCa detection remains a challenge, the ability of these biopsy methods to sample specific areas of the prostate more effectively has generated considerable interest. A recent study examined the diagnostic accuracy, complication rates, and clinical outcomes of TR and TP biopsy for biopsy-naïve patients, and those undergoing repeat biopsies. Findings suggest that the TP approach offers increased accuracy, particularly in patients with a history of negative biopsies.
The comprehensive analysis focused on studies comparing the TP and TR biopsy techniques in terms of their diagnostic accuracy and complications. The analysis included articles that evaluated both approaches in biopsy-naïve patients and those undergoing repeat biopsies, encompassing a range of factors such as infection rates, cancer detection rates, and procedural complications. In particular, the studies reviewed compared the two biopsy methods in scenarios where MRI-guided biopsies were used, as well as their effectiveness in detecting clinically significant PCa (csPCa) in different regions of the prostate.
The results revealed that, for biopsy-naïve patients, the overall cancer detection rates between TP and TR biopsies were comparable, ranging from 25%–56% for TR biopsies, and 35%–63% for TP. For csPCa, TR biopsy detection rates were 30.6%–87% and 36.9%–84.0% for TP. Notably, the TP approach demonstrated higher detection rates for anterior lesions, particularly in patients with a PSA range of 4–10 ng/mL. For repeated biopsies, TP biopsies showed an advantage in terms of cancer detection rates, with higher accuracy for both PCa and csPCa, especially in the anterior regions. The complication rates between both methods were similar, with the TP approach associated with lower rates of severe infections, but more discomfort.
Overall, both TR and TP biopsy techniques offer valuable diagnostic insights for PCa detection. While the TP approach does not significantly outperform TR in terms of overall cancer detection, it is particularly advantageous in repeat biopsy scenarios and for sampling anterior lesions. These findings suggest that TP biopsy may serve as a preferred method for patients with challenging PCa cases. Limitations of the study include variability in biopsy procedures and patient selection, and the lack of centralised review for some data. Further research will help solidify the role of the TP biopsy technique in clinical practice and guide future decisions on its widespread adoption.
Reference
Najjar s et al. Comparative Analysis of Diagnostic Accuracy and Complication Rate of Transperineal Versus Transrectal Prostate Biopsy in Prostate Cancer Diagnosis. Cancers (Basel). 2025;17(6):1006.
