Transperineal versus transrectal systematic prostate biopsy in routine clinical practice: a real-world comparative...

Area of Science:

• Urology
• Oncology
• Medical Imaging

Background:

• Prostate biopsy is crucial for diagnosing prostate cancer.
• Transrectal (TR) biopsy is common but has infectious risks and may miss anterior tumors.
• Transperineal (TP) biopsy is a safer alternative with lower infectious risk.

Purpose of the Study:

• To compare diagnostic yield, tissue quality, and complications of systematic TR versus TP prostate biopsy.
• To evaluate the effectiveness of TP biopsy in a Moroccan tertiary center.

Main Methods:

• Retrospective study of 139 men with suspected prostate cancer undergoing systematic TR or TP biopsy.
• Analysis focused on systematic cores, assessing median core length for quality.
• Complications were graded using the Clavien-Dindo classification.

Main Results:

• TP biopsy yielded longer median core length than TR biopsy (p=0.02).
• Detection rates for clinically significant prostate cancer (csPCa) were similar: 40.3% for TR vs. 38.9% for TP.
• Infectious complications were significantly lower after TP biopsy (1.4%) compared to TR biopsy (7.5%).

Conclusions:

• TP systematic biopsy achieves comparable csPCa detection to TR biopsy.
• TP biopsy offers improved tissue quality (longer cores) and reduced infectious complications.
• TP biopsy is recommended to decrease infectious morbidity without sacrificing diagnostic accuracy.