Comparison of prostate cancer detection rates and complications between transrectal ultrasound-guided transperineal and transrectal biopsies: a systematic review and meta-analysis.

Abstract

Background: Transrectal ultrasound (TRUS)-guided transperineal (TP) and transrectal (TR) approaches have been used for systematic prostate biopsy. A meta-analysis was conducted to compare the cancer detection rates (CDRs) and associated complications between TP and TR prostate biopsies.

Methods: PubMed, Web of Science, Embase, Cochrane Library, China Wanfang data, and China National Knowledge Infrastructure (CNKI) were searched for literature on TP and TR biopsies of the prostate from inception to September 2024.

Results: A total of 20 studies were included in the meta-analysis of 2,979 and 2,610 patients undergoing TP and TR biopsies, respectively. The pooled analysis indicated no significant difference in the CDR between the TP and TR biopsies [relative risk (RR) =0.98; 95% confidence interval (CI): 0.92-1.04; P=0.46]. Compared to the TR approach, the TP approach was associated with a lower risk of rectal bleeding (RR =0.05; 95% CI: 0.02-0.13; P<0.001), urinary retention (RR =0.70; 95% CI: 0.49-0.99; P=0.046), and fever (RR =0.24, 95% CI: 0.15-0.39; P<0.001). However, the risk of pain after the procedure was higher in the TP group (RR =2.04; 95% CI: 1.47-2.82; P<0.001). No significant difference was found in the risk of hematuria between the two groups (RR =1.05; 95% CI: 0.91-1.22; P=0.52).

Conclusions: TP and TR biopsies of the prostate have similar CDRs. Remarkably, compared to TR biopsy, TP biopsy involves a lower risk of rectal bleeding, urinary retention, and fever, but a higher risk of pain.