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Updated: Jan 29, 2026
05:35
Transperineal Prostate Biopsy Using a Cone-shaped Double-hole Method with Dual-plane Probe Guidance
Published on: June 6, 2025
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Transition from Transrectal Systematic to Transperineal Lesion-Focused Prostate Biopsy: A Real-World Comparative
Thibaut Long Depaquit1, Federica Sordelli1, Christopher Agüero1
1Department of Urology, Nord Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13005 Marseille, France.
Cancers
|January 28, 2026
Summary
The transperineal (TP) lesion-focused biopsy approach significantly improves detection of clinically significant prostate cancer (csPCa) compared to transrectal (TR) systematic biopsy. This method also reduces the overdiagnosis of low-grade prostate cancer.
Area of Science:
- Urology
- Oncology
- Medical Imaging
Background:
- Transperineal (TP) prostate biopsy offers improved safety over the transrectal (TR) approach.
- The diagnostic impact of TP lesion-focused biopsy on clinically significant prostate cancer (csPCa) detection, especially with modern strategies, requires further evaluation.
- Transitioning from TR systematic to TP lesion-focused biopsy strategies needs real-world assessment.
Purpose of the Study:
- To evaluate the real-world diagnostic impact of shifting from a TR systematic-based biopsy to a TP lesion-focused approach.
- To compare the detection rates of csPCa and lower-grade cancers between the two biopsy strategies.
Main Methods:
- Retrospective single-centre study of men undergoing image-guided prostate biopsy (2018-2025) with a single MRI-visible lesion (PI-RADS ≥ 3).
- Comparison of TR systematic biopsy (TR-SBx) versus TP lesion-focused biopsy (TP-LFx) using targeted and perilesional cores.
- Inverse probability of treatment weighting (IPTW) and doubly robust models adjusted for baseline differences.
Main Results:
- TP-LFx was associated with significantly higher csPCa detection (adjusted OR 2.52, p=0.002) compared to TR-SBx.
- TP-LFx demonstrated lower detection of Gleason Grade Group 1 cancer (OR 0.50, p=0.03), indicating reduced overdiagnosis.
- Stronger associations for TP-LFx were observed in patients with prior negative biopsies and for anterior/apical lesions.
Conclusions:
- Transitioning to a TP lesion-focused biopsy approach in clinical practice enhances csPCa detection.
- The TP lesion-focused strategy effectively reduces the overdiagnosis of low-grade prostate cancer.
- These findings support the adoption of TP lesion-focused MRI-guided biopsy for contemporary prostate cancer diagnostics.
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