Meta-Analysis of Transperineal and Transrectal Ultrasound-Guided Prostate Biopsy in the Detection of Prostate Cancer.

Abstract

Background: Transperineal (TP) biopsy is increasingly used as an alternative to standard transrectal (TR) biopsy for prostate cancer detection to reduce infection risks. However, evidence on comparative diagnostic accuracy remains inconclusive. The aim of this study was to perform an updated systematic review and meta-analysis of studies comparing prostate cancer detection rates between TP and TR ultrasound biopsies.

Methods: PubMed, EMBASE, Web of Science and other databases were searched for relevant studies up to December 2023. Randomised trials and observational studies comparing TP and TR biopsies were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random effects models. Heterogeneity was assessed, and subgroup analyses were conducted.

Results: Nine studies comprising four randomised controlled trials (RCTs) and five observational studies were analysed, including 2763 patients (1376 TP, 1387 TR). No significant difference was found in overall cancer detection rates between TP and TR biopsies (RR = 0.9762, 95% CI = 0.8225-1.1586 for random effects model). However, subgroup analysis found that the RCTs showed no difference (RR = 0.9681, 95% CI = 0.8491-1.1038), whereas the observational studies varied (RR = 0.9416, 95% CI = 0.8073-1.0983). Significant heterogeneity was present across studies (I² = 64.3%, p = 0.0156). Details on the prostate specific antigen (PSA) levels in the included studies were provided, and no significant differences were found between TP and TR biopsies regardless of whether a PSA threshold of >10 ng/mL or <10 ng/mL was used.

Conclusions: In summary, this updated meta-analysis found no significant difference between TP and TR biopsies in overall prostate cancer detection rates. The subgroup analysis highlighted that results from RCTs specifically indicated equivalence in diagnostic accuracy. TP biopsy may be considered an appropriate alternative to TR biopsy for patients requiring prostate biopsy.