Transperineal versus Transrectal Prostate Biopsy: Comparative Analysis of Cancer Detection and Complication Rates

Prostate cancer is the most common malignancy in men, and systematic ultrasound-guided biopsy remains the diagnostic gold standard. The transrectal (TR) route, while widely used, carries an increased risk of infectious and haemorrhagic complications. The transperineal (TP) biopsy approach has been developed to reduce these risks while maintaining comparable diagnostic accuracy. This study aimed to compare cancer detection rates, histopathological patterns, and complication rates between TP and TR prostate biopsies.

A retrospective analysis was conducted on 310 patients who underwent prostate biopsy between January 2023 and January 2024. Patients were divided into TP (n=178) and TR (n=132) groups. Clinically significant prostate cancer (csPCa) was defined as Gleason score ≥7 or ISUP grade ≥2. Data regarding detection rates, ISUP distribution, complications, and age were compared using the Chi-square test. Age distribution and ISUP grade across age decades were evaluated to exclude age-related bias.

The overall cancer detection rate was significantly higher in the TP group (60.67%) than in the TR group (49.24%) (p=0.045), while csPCa detection did not differ significantly (TP 49.44% vs TR 43.94%, p=0.20). High-grade (ISUP 5) tumours were more frequent in the TR group (41.5% vs 25.0%, p=0.034). Complications were significantly more common after TR biopsy (15.2% vs 6.7%, p=0.027), with infections and rectal bleeding occurring only in TR cases. Patient age distribution was similar between groups (χ²=4.49, p=0.213), and ISUP grade distribution by age decade showed no significant differences (all p>0.05). No non-prostatic pathology was identified in either cohort.

Transperineal prostate biopsy demonstrated a higher overall detection rate and significantly fewer complications compared to the transrectal approach, while maintaining equivalent detection of clinically significant prostate cancer. The absence of age-related or histological bias confirms that the lower complication rate of TP biopsy is attributable to the procedural route rather than patient-related factors.