Review of Transperineal and Transrectal Prostate Biopsy Outcomes

More than 2 million prostate biopsies are performed annually in the USA and Europe, but there is debate over the optimal approach. The procedural time is shorter for transrectal (TR) than for transperineal (TP) biopsy, but prospective randomized trials have demonstrated that TR biopsy has a greater risk of infectious complications and inferior cancer detection rates. As a result, professional guideline recommendations are shifting in favor of TP biopsy. Nevertheless, the TR approach still accounts for the majority of biopsies performed worldwide. Barriers to TP biopsy adoption include limited training opportunities, longer procedure duration, and higher costs in comparison to TR biopsy. PATIENT SUMMARY: A prostate biopsy is carried out for patients who have a suspicion for prostate cancer, but there is debate over the best biopsy approach. Transrectal (TR) biopsy takes less time than transperineal (TP) biopsy. Trials have shown that TR biopsy has a higher risk of infectious complications and a similar cancer detection rate. Guidelines are therefore shifting in favor of TP biopsy, although limited training opportunities, the longer procedure time, and higher costs are barriers to more widespread use of this approach.