A notable paradigm shift has emerged in the choice of prostate biopsy approach, with a transition from transrectal biopsy (TRBx) to transperineal biopsy (TPBx) driven by the lower risk of severe urinary tract infections.
The impact of this change on detection of clinically significant prostate cancer (csPCa) remains a subject of debate. Our aim was to compare the csPCa detection rate of TRBx and TPBx.
Patients who underwent magnetic resonance imaging (MRI)-targeted and systematic biopsies for clinically localized PCa at 15 European referral centers from 2016 to 2023 were included. A propensity score matching (PSM) analysis was performed to minimize selection biases. Logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
Of 3949 patients who met the study criteria, 2187 underwent TRBx and 1762 underwent TPBx. PSM resulted in 1301 matched pairs for analysis. Patient demographics and tumor characteristics were comparable in the matched cohorts. TPBx versus TRBx was associated with greater detection of csPCa, whether defined as International Society of Urological Pathology grade group ≥2 (51% vs 45%; OR 1.37, 95% CI 1.15-1.63; p = 0.001) or grade group ≥3 (29% vs 23%; OR 1.38, 95% CI 1.13-1.67; p = 0.001). Similar results were found when considering MRI-targeted biopsy alone and after stratifying patients according to tumor location, Prostate Imaging-Reporting and Data System score, and clinical features. Limitations include the retrospective nature of the study and the absence of centralized MRI review.
Our findings bolster existing understanding of the additional advantages offered by TPBx. Further randomized trials to fully validate these findings are awaited.
We compared the rate of detection of clinically significant prostate cancer with magnetic resonance imaging (MRI)-guided biopsies in which the sample needle is passed through the perineum or the rectum. Our results suggest that the perineal approach is associated with better detection of aggressive prostate cancer.
European urology focus. 2024 Mar 19 [Epub ahead of print]
Romain Diamand, Karsten Guenzel, Georges Mjaess, Yolène Lefebvre, Mariaconsiglia Ferriero, Giuseppe Simone, Alexandre Fourcade, Georges Fournier, Alexandre-Patrick Bui, Fayek Taha, Marco Oderda, Paolo Gontero, Katerina Rysankova, Adrian Bernal-Gomez, Alessandro Mastrorosa, Jean-Baptiste Roche, Gaelle Fiard, Rawad Abou Zahr, Guillaume Ploussard, Olivier Windisch, Quentin Novello, Daniel Benamran, Gina Delavar, Julien Anract, Nicolas Barry Delongchamps, Adam Halinski, Charles Dariane, Jan Benijts, Gregoire Assenmacher, Thierry Roumeguère, Alexandre Peltier
Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium. Electronic address: ., Department of Urology, Vivantes Klinikum am Urban, Berlin, Germany., Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium., Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium., Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy., Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France., Department of Urology, Centre Hospitalier Universitaire de Reims, Reims, France., Department of Urology, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy., Department of Urology, University Hospital Ostrava, Ostrava, Czechia; Department of Surgical Studies, Faculty of Medicine, Ostrava University, Ostrava, Czechia., Department of Urology, Clinique Saint-Augustin, Bordeaux, France., Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, Grenoble, France., Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France., Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland., Departement of Urology, Hôpital Cochin, Paris, France., Department of Urology, Klinika Wisniowa, Zielona Góra, Poland., Department of Urology, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France., Department of Urology, Cliniques de l'Europe-Saint Elisabeth, Brussels, Belgium.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/38508895