Association Between Race and Detection of Clinically Significant Prostate Cancer in Transperineal and Transrectal...

The apex-to-base transperineal (TP) prostate biopsy needle trajectory may better sample the anterior prostate than the transrectal approach. There is evidence that African American men are more likely to harbor anterior tumors, suggesting that TP biopsy would result in better detection in these men. We performed a secondary retrospective analysis of prospective randomized trial data to determine whether African American race is associated with anterior tumor location and better detection with TP biopsy.

We examined data from 1404 patients (n = 199 African American) from two randomized trials (NCT04815876 and NCT04843566) comparing TP and TR biopsies. Differences in clinically significant (grade group ≥2) prostate cancer by biopsy approach and race were assessed using logistic regression, with adjustment for age, Prostate Imaging-Reporting and Data System (PI-RADS) score, prostate-specific antigen, and biopsy indication. Secondary outcomes included detection by PI-RADS score and anterior tumor presence in relation to race.

African American men had a higher risk of clinically significant prostate cancer (odds ratio [OR] 1.70, 95% confidence interval [CI] 1.20-2.42; p = 0.003) in comparison to White men. However, the interaction term between race and biopsy approach was nonsignificant (p = 0.4), with no evidence of preferential detection of clinically significant cancer via TP biopsy in African American men. Moreover, there was no difference in anterior tumor location (OR 1.20, 95% CI 0.76-1.87; p = 0.4), and TP biopsy did not improve the detection of anterior tumors overall (OR 0.95, 95% CI 0.68-1.32; p = 0.7).

Decisions about prostate biopsy that concern route or tumor location should be made independently of race.