Transition to targeted transperineal prostate biopsies does not impact progression to curative treatment for patients...

Concerns over infection have driven a shift from transrectal to transperineal prostate biopsy, while pre-biopsy MRI has promoted a move from systematic to targeted sampling. These changes may impact patient selection, treatment planning, and risk stratification in active surveillance.

To compare active surveillance outcomes of patients diagnosed primarily by targeted transperineal (tTP) biopsy versus standard transrectal (sTR) biopsy.

Prospectively collected data of men who underwent prostate biopsy between January 2018 and May 2022 who were included into active surveillance in our institution.

Comparison of patient characteristics, clinical and radiological features, positive and total number of biopsies, biopsy Gleason grade group (GG) at inclusion using simple descriptive statistics, groups compared using Wilcoxon rank sum test; Fisher's exact test; Pearson's Chi-squared test. Time to transition to curative treatment was calculated using the Kaplan-Meier plot.

There were 112 and 167 patients in the tTP and sTR groups, respectively. No significant differences in age, BMI, ECOG, Charlson Comorbidity Index, PSA, radiological T-stage or GG at inclusion was seen. Number of positive biopsy cores were unchanged between tTP and sTR at 2 (1-3) (median (IQR); p = 0.2), while total cores were reduced significantly to 3 (3-5) from 12 (8-12) (p < 0.001), respectively. Overall, there was no difference in progression from surveillance to active treatment (p = 0.084), but when separated by biopsy type and GG, there was a significantly higher rate of transitioning to curative treatment after 1 year in the sTR group with GG2+ at inclusion (p < 0.0001), compared to the other three.

Using targeted transperineal biopsy of the index lesion(s) alone does not lead to increased treatment of patients included in active surveillance.