Is transperineal prostate biopsy through a single access point safe and reproducible?

Abstract

Purpose To compare the complication rates and diagnostic efficacy between transperineal single-access ultrasound-guided prostate biopsy (TPPB) and transrectal ultrasound-guided prostate biopsy (TRPB) among patients with suspected prostate cancer. Methods We collected and analyzed data from 241 patients with prostate cancer suspicion and divided them into two groups: 171 TPPB and 70 TRPB. For the detection of complications associated with the technique, patients were followed–up for 3 months; furthermore, histopathological results to confirm prostate cancer were compiled. Results Histopathological reports showed 132 patients with malignancy (54.77%) and 109 with negative results (45.22%). TPPB detected malignancy in 60.2% of patients, compared with 41.4% detected by TRPB (p = 0.008). The most frequent complications in TPPB were hematuria (53.8%), post-procedural pain (6.4%), hematospermia (6.4%), and acute urinary retention (2.3%). All patients undergoing TRPB experienced pain during and after the procedure (p < 0.001). The TPPB technique was shown to be a protective factor against the development of complications (OR 0.028, 95% CI 0.009–0.09; p < 0.001). In contrast, complications associated with the TRPB technique were significantly higher (OR 35.5, 95% CI 10.7–117.6; p < 0.001). Conclusion Transperineal single-access prostate biopsy offers greater capability for prostate cancer detection and should be adopted as the first-choice method for prostate cancer diagnosis given its lower rates of infectious complications and can be performed on an outpatient basis with local anesthesia and sedation, without the need for prior intestinal preparation or antibiotic prophylaxis.