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JU INSIGHT Clinically Significant Prostate Cancer Detection Following Transrectal and Transperineal Biopsy

By: Badar M. Mian, MD, Albany Medical Center, New York; Paul J. Feustel, MD, Albany Medical Center, New York; Asef Aziz, MD, Albany Medical Center, New York; Ronald P. Kaufman Jr, MD, Albany Medical Center, New York; Adrien Bernstein, MD, Albany Medical Center, New York; Hugh A. G. Fisher, MD, Albany Medical Center, New York | Posted on: 17 Jul 2024

Mian BM, Feustel PJ, Aziz A, Kaufman RP Jr, Bernstein A, Fisher HAG. Clinically significant prostate cancer detection following transrectal and transperineal biopsy: results of the Prostate Biopsy Efficacy and Complications Randomized Clinical Trial. J Urol. 2024;212(1):21-31. doi:10.1097/JU.0000000000003979

Study Need and Importance

Transperineal prostate biopsy procedure has been utilized with increased frequency over the last few years for reasons including a potentially improved cancer detection when compared to the traditional transrectal prostate biopsy. Expert recommendations have favored transperineal biopsy based on several observational studies demonstrating higher yield of clinically significant prostate cancer and anteriorly located prostate cancer. However, level 1 evidence regarding the diagnostic performance of these 2 procedures is lacking. Thus, we designed a randomized clinical trial to determine clinically significant (Grade Group ≥2) prostate cancer detection following transrectal and transperineal biopsy.

What We Found

Eight hundred forty men were randomized to undergo either the transrectal or transperineal prostate biopsy procedure under local anesthesia using software-based fusion technique. The biopsy procedures included obtaining targeted as well as systematic biopsy cores. The clinically significant prostate cancer detection rates were similar amongst the procedures at 47.1% and 43.2% following transrectal and transperineal prostate biopsy, respectively. In biopsy-naïve men with a positive MRI, clinically significant prostate cancer was detected in 59% and 62% following transrectal and transperineal biopsy, respectively. In men with a positive MRI (PIRADS [Prostate Imaging Reporting and Data System] 3-5), and those with an anterior lesion on the MRI, the clinically significant cancer detection rates were also similar amongst the procedures (Figure). The diagnostic yield of clinically significant prostate cancer for each PIRADS score was also similar amongst the 2 procedures.

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Figure. Clinically significant prostate cancer detection in various subgroups following transrectal and transperineal prostate biopsy procedures.

Limitations

The centralization of both biopsy procedures to a single center (due to availability of technology, equipment, staff) can limit generalizability to other settings, although the pragmatic design features can mitigate some of those concerns. Further, the vast majority of participants were White, and the cancer detection rates may not be applicable to other ethnic groups.

Interpretation for Patient Care

There was no difference in the detection of clinically significant prostate cancer between the transrectal and the transperineal prostate biopsy procedures regardless of the MRI findings or tumor location.

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