Transperineal versus Transrectal Prostate Biopsy: A Systematic Review and Meta-Analysis of Randomized Controlled...

Area of Science:

• Urology
• Oncology
• Diagnostic Imaging

Background:

• Prostate cancer diagnosis relies on accurate imaging and biopsy.
• Transperineal (TP) and transrectal (TR) approaches are used for ultrasound-guided prostate biopsies.
• Randomized controlled trials (RCTs) are crucial for comparing the safety and efficacy of these biopsy techniques.

Purpose of the Study:

• To systematically compare the diagnostic performance and safety of transperineal (TP) versus transrectal (TR) ultrasound-guided prostate biopsies.
• To analyze data exclusively from randomized controlled trials (RCTs) to ensure robust evidence.
• To evaluate primary endpoints of cancer detection rates and postbiopsy infection rates, along with secondary outcomes like complications and pain.

Main Methods:

• A systematic literature search was conducted across multiple databases up to May 2025.
• Included only RCTs directly comparing TP and TR biopsy methods in men undergoing MRI-targeted prostate biopsies.
• Meta-analysis was performed using odds ratios (OR) and 95% confidence intervals (CI) for categorical outcomes, assessing study quality with Cochrane ROB2 and GRADE.

Main Results:

• Four RCTs with 2682 patients (TP: 1323; TR: 1359) were analyzed.
• No significant differences were found in overall cancer detection rates (OR 1.03) or anterior lesion detection (OR 1.01).
• Bleeding (OR 1.14), urinary retention (OR 1.01), total infections (OR 1.02), and severe infections (OR 2.17) showed no significant differences. Mild pain was more frequent in the TP group (OR 1.56), but moderate-to-severe pain did not differ significantly (OR 0.65).

Conclusions:

• Transperineal and transrectal MRI-fusion-guided biopsy approaches demonstrate equivalent diagnostic accuracy and safety profiles.
• While the transperineal route may be associated with slightly increased mild discomfort, cancer detection and complication rates are comparable.
• The choice between TP and TR biopsy should consider antimicrobial stewardship, patient preference, and institutional expertise.