Transperineal or Transrectal Magnetic Resonance Imaging-targeted Biopsy for Prostate Cancer Detection

Area of Science:

• Urology
• Oncology
• Medical Imaging

Background:

• A shift from transrectal biopsy (TRBx) to transperineal biopsy (TPBx) is occurring in prostate cancer diagnostics, primarily due to reduced infection risks.
• The comparative efficacy of TPBx versus TRBx in detecting clinically significant prostate cancer (csPCa) remains under investigation.

Purpose of the Study:

• To compare the detection rates of csPCa between transperineal biopsy (TPBx) and transrectal biopsy (TRBx).

Main Methods:

• A propensity score matching (PSM) analysis was conducted on data from 3949 patients across 15 European centers (2016-2023).
• Magnetic resonance imaging (MRI)-targeted and systematic biopsies were analyzed.
• Logistic regression models were used to compare csPCa detection rates between the two biopsy approaches.

Main Results:

• After PSM, 1301 matched pairs (TPBx vs. TRBx) were analyzed, with comparable demographics and tumor characteristics.
• TPBx demonstrated a significantly higher detection rate for csPCa (International Society of Urological Pathology grade group ≥2: 51% vs. 45%; OR 1.37) and higher-grade csPCa (grade group ≥3: 29% vs. 23%; OR 1.38).
• These findings held true across various analyses, including MRI-targeted biopsies alone and stratified patient groups.

Conclusions:

• Transperineal biopsy (TPBx) is associated with superior detection of clinically significant prostate cancer compared to transrectal biopsy (TRBx).
• These results add to the evidence supporting the advantages of the TPBx approach.
• Further randomized controlled trials are recommended to validate these findings.