Transperineal bests transrectal prostate biopsy for cancer detection

Takeaway

• Transperineal prostate biopsy (TPBx) is better than transrectal prostate biopsy (TRBx) for detecting clinically significant prostate cancer.
• Exceptions are patients age ≥80 years, with PSA levels >20 ng/mL, or with lower prostate volume (PV).

Why this matters

• Understanding the differences between approaches can help reduce repeat biopsies and overtreatment.

Study design

• Researchers compared the detection rates of systematic 12-core TPBx vs TRBx, both guided by transrectal ultrasound, in patients with suspected prostate cancer (N=2962).
• Funding: National Natural Science Foundation of China; Shanghai Municipal Health Bureau.

Key results

• TPBx detected clinically significant prostate cancer in a higher proportion of patients overall (P<.001).
• TRBx detection rates were higher in patients who:
  • Were age ≥80 years: 80.4% vs 56.5% (P=.004).
  • Had PSA levels >20.1-100.0 ng/mL: 80.9% vs 69.1% (P=.040).
  • Had lower PV:
    • multivariable analysis OR, 0.982 (95% CI, 0.973-0.991; P<.001);
    • univariable analysis OR, 0.990 (95% CI, 0.983-0.997; P=.004).

Limitations

• The study was retrospective and limited to patient data from 2 Chinese hospitals.