Comparisons of efficacy and complications between transrectal and transperineal prostate biopsy with or without antibiotic prophylaxis

Transperineal Magnetic Resonance Imaging-Fusion Targeted Prostate Biopsy Utilizing the PrecisionPoint Transperineal Access System vs a Grid Template: An Assessment of Outcomes

OBJECTIVE

To compare PrecisionPoint and grid-based biopsies on rates of clinically significant prostate cancer (csPCa) detection and complications when transperineal MRI-fusion targeted biopsy is performed.

MATERIALS AND METHODS

We queried a prospectively maintained prostate biopsy database to identify men ages 18-89 who underwent transperineal MRI-fusion targeted prostate biopsies (including concurrent systematic biopsies) between August 1, 2020 and September 1, 2024. The primary outcome was detection of csPCa in the MRI region of interest. 30-day complications and overall rates of csPCa were examined at the patient level. Subgroup outcomes included cancer detection in anterior MRI lesions and stratification by prior biopsy status. Logistic regression was performed.

RESULTS

1134 MRI lesions in 890 patients were included in the analysis (PrecisionPoint: 542 patients/714 lesions; grid-based biopsy: 348 patients/420 lesions). There were no differences in prostate cancer detection between the two groups overall. For patients with a prior negative biopsy, a grid-based approach detected a higher rate of csPCa (P=.021). On logistic regression, biopsy approach was not a significant predictor of csPCa at either the patient (P=.797) or lesion (P=.473) levels. Complication rates and the ability to detect csPCa in anterior lesions were similar between approaches.

CONCLUSION

PrecisionPoint and grid-based biopsies identified similar rates of prostate cancer, including in anterior MRI lesions, when transperineal MRI-targeted prostate biopsy was performed in this cohort. Complication rates were low and did not differ based on technique.

Comparison of Urinary Tract Infection Rates Between Transperineal Prostate Biopsies with and Without Prophylactic Antibiotics: An Updated Systematic Review and Meta-Analysis

Background and Objectives: The European Association of Urology (EAU) Guidelines on Prostate Cancer note emerging evidence suggesting that antibiotic prophylaxis may not be necessary for transperineal prostate biopsies. However, formal recommendations are pending further research. This meta-analysis compares urinary tract infection (UTI) rates following transperineal prostate biopsies with and without antibiotic prophylaxis. Materials and Methods: We searched PubMed, EMBASE, and the Cochrane Library for relevant studies published up until June 2024. The inclusion criteria were as follows: (a) patients undergoing transperineal prostate biopsy; (b) comparisons between groups with and without antibiotic prophylaxis; and (c) outcomes including UTI and sepsis rates. Exclusion criteria were studies lacking a full text or appropriate control groups and duplicates. Quality assessment was conducted using the Scottish Intercollegiate Guidelines Network checklist. Results: Nine studies (two RCTs and seven non-RCTs) met the inclusion criteria. Analysis revealed no significant difference in UTI rates between groups with and without prophylaxis (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 0.50-2.31, I2 = 0%, p = 0.86). Similarly, sepsis rates did not differ significantly (OR: 1.35, 95% CI: 0.36-5.12, I2 = 0%, p = 0.66). Conclusions: Our meta-analysis found no significant differences in UTI and sepsis rates between transperineal prostate biopsies performed with or without antibiotic prophylaxis. However, patients at high risk for UTIs may still benefit from antibiotic prophylaxis. Larger, prospective randomized trials are necessary for more conclusive evidence.

Infectious complications following transperineal prostate biopsy with or without periprocedural antibiotic prophylaxis-a systematic review including meta-analysis of all comparative studies

BACKGROUND

Despite the relatively low infection rate following transperineal prostate biopsy (TPB), it remains unresolved whether periprocedural antibiotic prophylaxis (PAP) can be omitted. Our aim was to compare infectious complications (genitourinary infections/GUI, fever, sepsis, readmission rate, 30-day-mortality) following TPB, considering all studies of varying levels of evidence that enable a direct comparison between patients with and without PAP.

METHODS

We performed a comprehensive search in PubMed/Medline, Embase, Web of Science, and Cochrane databases, as well as grey literature sources, to identify reports published until January 2024. All studies comparing the incidence of infectious endpoints following TPB with vs. without PAP were included in the analyses. The GRADE approach was employed to assess the certainty of evidence for each comparison.

RESULTS

Twenty-three studies met the inclusion criteria involving 6520 and 5804 patients who underwent TPB with vs. without PAP, respectively. Two of the 23 studies were randomized-controlled trials, not all studies investigated all endpoints. Pooled incidences between patients with vs. without PAP for the endpoints GUI (0.50% vs. 0.37%), fever (0.44% vs. 0.26%), sepsis (0.16% vs. 0.13%), and readmission rate (0.35% vs. 0.29%) showed no significant differences (all p > 0.250). The corresponding odds ratios (including 95% confidence interval) also revealed no statistically significant differences: 1.37 (0.74-2.54) [GUI], 0.87 (0.28-2.66) [fever], 1.30 (0.46-3.67) [sepsis], and 1.45 (0.70-3.03) [readmission rate]. No study reported events regarding 30-day-mortality. In subgroup analyses and sensitivity analyses, TPB without PAP showed no significantly higher complication rates regarding all analyzed endpoints.

CONCLUSIONS

Infectious complications after TPB occur very rarely and cannot be further reduced by PAP. Considering the results of this systematic review and adhering to the principles of effective antibiotic stewardship, omitting PAP in the context of TPB is advisable.

Comparing the Efficacy and Safety of the Transperineal Versus Transrectal Prostate Biopsy Approach in the Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis

Prostate cancer (PCa) has high prevalence rates in men and is a leading cause of cancer-related death. Transrectal (TR) biopsy has traditionally been the gold standard for diagnosis, but transperineal (TP) biopsy is increasingly favoured due to its lower infection risk. However, debate remains regarding which method has superior cancer detection rates. This review compares the efficacy and safety of the TP as compared to the TR prostate biopsy approach, summarizing the largest body of evidence available to date. A literature search was performed on the PubMed, Google Scholar, Cochrane Library, and Embase databases. We searched from the inception of the databases up to August 2024 for relevant studies comparing the cancer detection rate of TP versus TR prostate biopsy and compared their complication rates. Twenty-one studies met the inclusion criteria. The pooled odds ratios with 95% confidence intervals were calculated to evaluate the differences between the TR and TP groups in the PCa detection rate. This meta-analysis included 21 studies (6 randomized control trials and 15 cohort studies) with a total of 13,818 patients (TP = 7917; TR = 5901), who were accrued between 2008 and 2024 and divided into the TR group and the TP group. The analysis revealed no significant difference in prostate cancer detection rates between the TP and TR approaches in both RCTs (OR 1.02, 95% CI (0.74, 1.41), p = 0.90) and cohort studies (OR 1.07, 95% CI (0.85, 1.35), p = 0.36). Complication profiles were largely comparable; TP demonstrated a significantly lower risk of urinary tract infections (OR 0.26, 95% CI (0.11, 0.61)) but no notable differences in acute urinary retention, haematuria, or rectal bleeding. Our findings advocate the TP approach as a safer biopsy alternative where feasible, particularly in infection-sensitive populations, without compromising diagnostic accuracy. MRI should complement biopsy strategies to enhance diagnostic precision. Future research should focus on standardized, large-scale RCTs to further refine and personalize prostate cancer diagnostic pathways.

Transperineal prostate biopsy guided by which ultrasound transducer: transrectal or transperineal: a retrospective study

Background

Prostate biopsies are primarily conducted using either the transrectal or transperineal approach, with the ultrasound probe positioned in the rectum to obtain a clear view of the prostate. Reports on the utilization of transperineal prostate biopsies with the ultrasound probe placed on the perineal skin are limited.

Methods

A retrospective investigation was conducted on 119 patients who underwent transperineal ultrasound guided transperineal prostate biopsy (TP-TPPB). Additionally, 85 patients who underwent transrectal ultrasound guided transperineal prostate biopsy (TR-TPPB) were included as controls. The prostate cancer detection rates (PCDRs) and postoperative complication rates were compared between the two groups, and their application values were also evaluated.

Results

The overall PCDRs were 35.3% (42/119) in the TP-TPPB and 32.9% (28/85) in the TR-TPPB group (χ2 = 0.122, p = 0.727). When categorized by PSA level, there was no significant difference between the two groups in PCDRs in any category (p > 0.05). However, the single-needle PCDRs in some regions (L4, L5, R2, and apex) showed significant differences (p < 0.05). There was no difference in postoperative complication rates between the groups.

Conclusion

The PCDRs and the postoperative complication rates of TP-TPPB and TR-TPPB are similar. However, TP-TPPB requires simpler equipment and does not require intestinal preparation, which is especially useful for patients with rectal contraindications, such as those with severe hemorrhoids and rectal/anal diseases.

Transrectal versus transperineal prostate biopsy for cancer detection in patients with gray-zone prostate-specific antigen: a multicenter, real-world study

Knowledge about the effect of different prostate biopsy approaches on the prostate cancer detection rate (CDR) in patients with gray-zone prostate-specific antigen (PSA) is limited. We performed this study to compare the CDR among patients who underwent different biopsy approaches and had rising PSA levels in the gray zone. Two hundred and twenty-two patients who underwent transrectal prostate biopsy (TRB) and 216 patients who underwent transperineal prostate biopsy (TPB) between June 2016 and September 2022 were reviewed in this study. In addition, 110 patients who received additional targeted biopsies following the systematic TPB were identified. Clinical parameters, including age, PSA derivative, prostate volume (PV), and needle core count, were recorded. The data were fitted via propensity score matching (PSM), adjusting for potential confounders. TPB outperformed TRB in terms of the CDR (49.6% vs 28.3%, P = 0.001). The clinically significant prostate cancer (csPCa) detection rate was not significantly different between TPB and TRB (78.6% vs 68.8%, P = 0.306). In stratified analysis, TPB outperformed TRB in CDR when the age of patients was 65-75 years (59.0% vs 22.0%, P < 0.001), when PV was 25.00-50.00 ml (63.2% vs 28.3%, P < 0.001), and when needle core count was no more than 12 (58.5% vs 31.5%, P = 0.005). The CDR ( P = 0.712) and detection rate of csPCa ( P = 0.993) did not significantly differ among the systematic, targeted, and combined biopsies. TPB outperformed TRB in CDR for patients with gray-zone PSA. Moreover, performing target biopsy after systematic TPB provided no additional benefits in CDR.

A novel simplified transperineal prostate biopsy guided by perineal ultrasound

BACKGROUND

Prostate biopsies are mainly performed through transrectal or perineal approaches, while ultrasound probes are located in the rectum for guidance. However, reports on the use of perineal ultrasound-guided transperineal prostate biopsy (PG-TPPB) are few.

METHODS

A retrospective case-control study was designed. A total of 111 patients who underwent PG-TPPB from February 2019 to December 2020 were investigated retrospectively. Simultaneously, 188 patients who underwent transrectal prostate biopsy (TRPB) were included as control. The prostate cancer detection rates (PCDR), complication rates, and application values were compared between the 2 groups.

RESULTS

The overall PCDR in the PG-TPPB and TRPB groups were 33.3% (37/111) and 39.9% (75/188), respectively (P = .258). There was no significant difference in the PCDR between the 2 groups under each prostate-specific antigen level (all P > .05). The single-needle PCDR in the PG-TPPB and TRPB groups were 21.5% (277/1 287) and 24.0% (513/2 134), respectively (P = .091). The incidence of complications in the PG-TPPB group was significantly lower than that in the TRPB group (8.1% vs 21.3%, P = .003).

CONCLUSIONS

The PCDRs of PG-TPPB and TRPB were the same. However, the postoperative complication rate of PG-TPPB was significantly lower than that of TRPB. Moreover, PG-TPPB required simpler equipment and did not require enema administration, which is suitable for patients with rectal contraindications.

ADVANCES IN KNOWLEDGE

The reports on PG-TPPB are few. Our study indicated that PG-TPPB reduced the postoperative complication rate. Moreover, PG-TPPB required simpler equipment. Importantly, PG-TPPB is suitable for patients with rectal contraindications.