Transperineal biopsy as a new technique versus well-established transrectal biopsy for diagnosis of prostate cancer – A comparative study

Transrectal (TR) prostate biopsy has been the gold standard for prostate cancer diagnosis for years. With the emergence of transperineal (TP) prostatic biopsy, there is a shift in practice across medical services to adopt TP biopsy as the primary method of prostatic biopsy. The objective of the study is to compare cancer detection rates and complications between TP and TR biopsies in our region providing single-center experience with introduction of TP biopsy. This is a retrospective study utilizing a prospectively designed database comparing consecutive 80 cases of TP biopsy to 80 cases of TR biopsy in a single center. Prebiopsy PSA was 14.2 ± 24.9 ng/dl in the TP group versus 23.7 ± 71.3 ng/dl in the TR group with P = 0.108. Prostate Imaging–Reporting and Data System (PIRAD) 4 and 5 lesions were found in 47 (58.9%) cases of TP biopsy versus 44 (60.3%) of TR group cases and P = 0.131. Cancer was detected in 49 (61.25%) patients in the TP group versus 45 (56.25%) in the TR group with no statistically significant difference and P = 0.665. No cases of hematochezia was reported in TP group, vs 14 (17.5%) reported in TR group with P value <.001. There were no statistically significant differences regarding the incidence of febrile urinary tract infection (UTI), hematuria, and hematospermia in the TP group 0 (0%), 7 (8.75%), and 3 (3.75%) versus 2 (2.50%), 14 (17.50%), and 5 (6.25%) in the TR group with P = 0.497, 0.159, and 0.719 consecutively. TP and TR biopsy have comparable cancer detection rates. TP biopsy has a significantly lower rectal bleeding rate than TR biopsy. There is a trend toward lower febrile UTI in the TP group; however, it did not reach statistical significance.