Prostate Biopsy: The Transperineal Approach

Abstract

Objective

Review the literature concerning transperineal transrectal ultrasound (TRUS)-guided prostate biopsy (PBx), providing an update on the topic.

Methods

The literature review was performed using PubMed through a free text search strategy. The authors reviewed the abstracts of the retrieved records to select the relevant papers.

Results

The search retrieved 196 records; 68 were relevant to the issue. No high-level evidence recommends a particular kind of preparation/prophylaxis for transperineal PBx. It can be performed with a brachytherapy template under general or spinal anesthesia, or with a local periprostatic nerve block through a single-access fan technique. In the former case, up to 50 cores are obtained; in the latter, 12–26 cores. Prostate cancer detection rates range from 24% to 51%, with figures of 27–49% in patients undergoing their first PBx for a prostate-specific antigen level of 4–10 ng/ml. Such percentages are directly related to the number of cores obtained. In repeat biopsy and in prostates > 50 cc, the number of cores should be increased, paying particular attention in sampling the anterior zone. Among the studies comparing transrectal and transperineal PBx, only two demonstrated differences in detection rates in favor of the transperineal approach. Major complications are rare, with fever occurring in 0–5.2% and hospitalization in 0–1.4% of cases.

Conclusion

Transperineal TRUS-guided PBx is a safe procedure, with high detection rates and wide applications both in first and in repeat sampling. Although having a strong rationale, the transperineal approach has so far not resulted in higher detection rates than transrectal biopsies.