Comparing outcomes of transperineal to transrectal prostate biopsies performed under local anaesthesia

OBJECTIVES: To compare and review the outcomes of transperineal (TP) prostate biopsies with transrectal (TR) biopsies performed under local anaesthesia (LA). A review of the relevant published literature is presented. PATIENTS AND METHODS: We prospectively analysed 212 consecutive patients who underwent TP prostate biopsy using the PrecisionPoint™ access system under LA, at our institution from October 2018 to March 2020. We compared the morbidity and cancer detection rates using this approach with our historical cohort of 178 patients who underwent the TR biopsy method under LA. RESULTS: The mean age of the TP biopsy group was 69 years, and median prostate specific antigen (PSA) was 13.17 ng/ml. Mean prostate volume was 45.1 ml with a median of 12 cores taken per patient. Patient demographics were similar to our TR biopsy cohort, with mean age of 68 years, median PSA of 10.76, mean prostate volume of 49.6 ml and a median of 12 cores taken per patient. The TP biopsy group had 0% sepsis rate compared with 2.2% in the TR group. Haematuria in the TP versus transrectal ultrasonography (TRUS) cohort was 0.9% versus 1.7%, respectively. The TP biopsy‐naïve group had a cancer detection rate of 63.5% (127 of 200 patients), of which 84% were ≥Grade Group 2 (GG2). The TR biopsy‐naïve group had cancer detection rate of 50% (86 of 172 patients), of which 87.2% was ≥GG2. CONCLUSION: TP prostate biopsy had less urinary infectious and septic complications compared with the TR approach. Our data suggest at least comparable diagnostic accuracy between both biopsy approaches.