Efficacy of Prostate Biopsies via Transperineal and Transrectal Routes for Significant Prostate Cancer Detection: A...

Area of Science:

• Urology
• Oncology
• Medical Imaging

Background:

• Transperineal prostate biopsy is recommended over transrectal biopsy to minimize infectious complications.
• Magnetic resonance imaging (MRI) is increasingly used to guide prostate biopsies.
• Comparing the efficacy of transperineal versus transrectal biopsy for detecting significant prostate cancer (sPCa) is crucial.

Purpose of the Study:

• To compare the efficacy of transperineal and transrectal MRI-guided biopsies in detecting sPCa.
• To evaluate the role of systematic biopsies in conjunction with MRI-guided targeted biopsies.
• To assess detection rates based on index lesion localization.

Main Methods:

• Prospective, multicenter trial (2021-2023) involving 4029 men suspected of PCa.
• Retrospective analysis of 1376 men with index lesion data, with a matched cohort of 325 pairs for transrectal and transperineal biopsies.
• Comparison of sPCa detection rates from index lesion-targeted and systematic biopsies, stratified by biopsy route and lesion location.

Main Results:

• Transperineal biopsies detected sPCa in 49.5% vs. 40.6% overall (p=0.027) and 44.6% vs. 30.8% from index lesions (p=0.001).
• Higher sPCa detection rates for transperineal biopsies were observed across all index lesion localizations, notably in the anterior zone and apex.
• Systematic biopsies detected sPCa in 24.3% (transperineal) vs. 35.1% (transrectal) (p=0.003), indicating reduced utility with the transperineal approach.

Conclusions:

• Transperineal targeted biopsies demonstrate superior sPCa detection rates compared to transrectal biopsies, particularly for anterior and apical tumors.
• The utility of systematic biopsies appears reduced when employed with transperineal targeted biopsies.
• The transperineal approach is an effective method for MRI-guided prostate cancer detection.