Efficiency and safety of transperineal prostate biopsy with a single access point
Main Article Content
Keywords
Biopsy, Prostate, Prostatic Neoplasms, Prostate-Specific Antigen, Prostate Cancer
Abstract
Abstract
Background: Prostate cancer (PCa) is the most common neoplasm in men. Transrectal prostate biopsy is the standard for diagnosing PCa, but it presents complications. Transperineal biopsy has gained popularity due to its better detection rates and fewer complications.
Objective: To compare the efficiency and complication rates between single-access point transperineal prostate biopsy (TPPB) and transrectal prostate biopsy (TRPB) in patients with suspected PCa.
Material and methods: Information was collected and analyzed from 241 patients with suspected PCa, divided into 2 groups: 171 in the TPPB group and 70 in the TRPB group. Pathology results were collected and complications were identified.
Results: Out of the 241 patients, 132 had positive biopsies (54.77%) and 109 negative (45.22%). TPPB was positive in 60.2%, compared to 41.4% of TRPB (p = 0.008). Complications in TPPB were hematuria (53.8%), pain (6.4%), hemospermia (6.4%), and acute urinary retention (2.3%). TPPB shown to be a protective factor for complications (odds ratio [OR] 0.028, 95% confidence interval [95% CI] 0.009-0.9; p < 0.001), compared to the TRPB technique (OR 35.5, 95% CI 10.7-117.6; p < 0.001).
Conclusions: TPPB offers a better detection rate for PCa and it should be adopted as the first-choice method for PCa diagnosis, given that it has a lower complication rate and can be performed without the need for bowel preparation or antibiotic prophylaxis.
References
1. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12-49. doi: 10.3322/caac.21820
2. Rico L, Contreras P, Blas L, et al. ¿Es la biopsia de próstata transperineal más eficaz y segura que la biopsia transrectal?* Rev Argent Urol. 2018;83(1):5-11.
3. DiBianco JM, Mullins JK, Allaway M. Ultrasound guided, freehand transperineal prostate biopsy: An alternative to the transrectal approach. Urol Pract. 2016;3(2):134-40. doi: 10.1016/j.urpr.2015.05.007
4. Tristán-Martínez PD, Doubova SV, Sauceda-Valenzuela AL. Calidad de atención en pacientes con cáncer de próstata atendidos en México. Rev Med Inst Mex Seguro Soc. 2022;60(3):275-82.
5. Sánchez-Martínez LC, Paredes-Solís CA, Hernández-Ordoñez OF, et al. El antígeno prostático específico. Su papel en el diagnóstico del cáncer de próstata. Rev Med Inst Mex Seguro Soc. 2013;51(2):124-6. Disponible en: http://www.redalyc.org/articulo.oa?id=457745488001
6. Taylor AK, Zembower TR, Nadler RB, et al. Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care. J Urol. 2012;187(4):1275-9. doi: 10.1016/j.juro.2011.11.115
7. Lu M, Luo Y, Wang Y, et al. Transrectal versus transperineal prostate biopsy in detection of prostate cancer: a retrospective study based on 452 patients. BMC Urol. 2023;23(1):11. doi: 10.1186/s12894-023-01176-y
8. Moreno-Palacios J, Espinosa-Guerrero A, Torres-Anguiano JR, et al. Iodopovidona intrarrectal y riesgo de infección genitourinaria posterior a biopsia prostática transrectal. Rev Med Inst Mex Seguro Soc. 2015;53(6):728-31. Disponible en: http://www.redalyc.org/articulo.oa?id=457744940010
9. Sidana A, Blank F, Wang H, et al. Schema and cancer detection rates for transperineal prostate biopsy templates: a review. Ther Adv Urol. 2022;14:17562872221105019. doi: 10.1177/17562872221105019
10. Leung AK, Patil D, Howard DH, et al. Payments and patient cost sharing for prostate biopsies according to image guidance, practice site and use of anesthesia. Urol Pract. 2020;7(2):138-44. doi: 10.1097/UPJ.0000000000000073
11. Lichtbroun BJ, Patel M, Consalvo A, et al. Transperineal prostate biopsy without routine antibiotics demonstrates decreased infection risk. Can J Urol. 2025;32(1):55-62. doi: 10.32604/cju.2025.064701
12. Meyer AR, Joice GA, Schwen ZR, et al. Initial experience performing in-office ultrasound-guided transperineal prostate biopsy under local anesthesia using the PrecisionPoint Transperineal Access System. Urology. 2018;115:8-13. doi: 10.1016/j.urology.2018.01.021
13. Garza-Montúfar ME, Treviño-Valdez PD, De la Garza-Salinas LH. Resistencia bacteriana y comorbilidades presentes en pacientes urológicos ambulatorios con urocultivos positivos. Rev Med Inst Mex Seguro Soc. 2018;56(4):347-53. Disponible en: http://www.redalyc.org/articulo.oa?id=457758020006
14. Leboutte F, Schykowski T, Van de Plas J, et al. Retrospective, single center evaluation of transperineal prostate biopsy omitting antibiotic prophylaxis and omitting periinterventional screening for bacteriuria. World J Urol. 2025;43(1):378. doi: 10.1007/s00345-025-05672-8
15. Sigle A, Suarez-Ibarrola R, Pudimat M, et al. Safety and side effects of transperineal prostate biopsy without antibiotic prophylaxis. Urol Oncol. 2021;39(11):782.e1-782.e5. doi: 10.1016/j.urolonc.2021.02.016
16. Ramírez-Backhaus M, Trassierra-Villa M, Arlandis-Guzmán S, et al. Estrategias para la biopsia de próstata. Revisión de la literatura. Actas Urol Esp. 2007; 31(10). Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0210-48062007001000001
17. Xiang J, Yan H, Li J, et al. Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: a systematic review and meta-analysis. World J Surg Oncol. 2019;17(1):31. doi: 10.1186/s12957-019-1573-0
18. Jiang CY, Shen PF, Wang C, et al. Comparison of diagnostic efficacy between transrectal and transperineal prostate biopsy: A propensity score-matched study. Asian J Androl. 2019;21(6):612-7. doi: 10.4103/aja.aja_16_19
19. Gnanapragasam VJ, Leonard K, Sut M, et al. Multicentre clinical evaluation of the safety and performance of a simple transperineal access system for prostate biopsies for suspected prostate cancer: The CAMbridge PROstate Biopsy DevicE (CamPROBE) study. J Clin Urol. 2020;13(5):364-70. doi: 10.1177/2051415820932773
20. Ngu IS, Ngooi MS, Ng HK, et al. Freehand transperineal prostate biopsy with a coaxial needle under local anesthesia: Experience from a single institution in Malaysia. Cancer Pathog Ther. 2023;1(1):33-9. doi: 10.1016/j.cpt.2022.12.001
21. Calleris G, Marquis A, Zhuang J, et al. Impact of operator expertise on transperineal free-hand mpMRI-fusion-targeted biopsies under local anaesthesia for prostate cancer diagnosis: a multicenter prospective learning curve. World J Urol. 2023;41(12):3867-76. doi: 10.1007/s00345-023-04642-2
22. Derin O, Fonseca L, Sanchez-Salas R, et al. Infectious complications of prostate biopsy: winning battles but not war. World J Urol. 2020;38(11):2743-53. doi: 10.1007/s00345-020-03112-3
23. Borghesi M, Ahmed H, Nam R, et al. Complications after systematic, random, and image-guided prostate biopsy. Eur Urol. 2017;71(3):353-65. doi: 10.1016/j.eururo.2016.08.004
24. Power J, Murphy M, Hutchinson B, et al. Transperineal ultrasound-guided prostate biopsy: what the radiologist needs to know. Insights Imaging. 2022;13(1):77. doi: 10.1186/s13244-022-01210-x
25. Pepe P, Pennisi M. Morbidity following transperineal prostate biopsy: Our experience in 8.500 men. Arch Ital Urol Androl. 2022;94(2):155-9. doi: 10.4081/aiua.2022.2.155
26. Bryant RJ, Marian IR, Williams R, et al. Local anaesthetic transperineal biopsy versus transrectal prostate biopsy in prostate cancer detection (TRANSLATE): a multicentre, randomised, controlled trial. Lancet Oncol. 2025;26(5):583-95. doi: 10.1016/S1470-2045(25)00100-7
27. Castellani D, Pirola GM, Law YXT, et al. Infection rate after transperineal prostate biopsy with and without prophylactic antibiotics: Results from a systematic review and meta-analysis of comparative studies. J Urol. 2022;207(1):25-34. doi: 10.1097/JU.0000000000002251
28. Sivaraman A, Ramasamy V, Aarthy P, et al. Safety and feasibility of freehand transperineal prostate biopsy under local anesthesia: Our initial experience: Our initial experience. Indian J Urol. 2022;38(1):34-41. doi: 10.4103/iju.iju_222_21
29. Thomson A, Li M, Grummet J, et al. Transperineal prostate biopsy: a review of technique. Transl Androl Urol. 2020;9(6):3009-17. doi: 10.21037/tau.2019.12.40
30. Lopez JF, Campbell A, Omer A, et al. Local anaesthetic transperineal (LATP) prostate biopsy using a probe-mounted transperineal access system: a multicentre prospective outcome analysis. BJU Int. 2021;128(3):311-8. doi: 10.1111/bju.15337
31. Hong A, Hemmingway S, Wetherell D, et al. Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible. ANZ J Surg. 2022;92(6):1480-5. doi: 10.1111/ans.17593
32. Kum F, Elhage O, Maliyil J, et al. Initial outcomes of local anaesthetic freehand transperineal prostate biopsies in the outpatient setting. BJU international. 2020;125(2):244-52. doi: 10.1111/bju.14620
33. Bujaldon JM, Vitagliano GJ, Blas L, et al. Freehand Transperineal Prostate Biopsy Improves the Detection Rate of Clinically Significant Prostate Cancer. Urology Research & Practice. 2025;50(5):269-74. doi: 10.5152/tud.2025.24026
34. Pilatz A, Stangl F, Kranz J, et al. Transperineal is the way to go. Eur Urol Focus. 2024;10(5):691-3. doi: 10.1016/j.euf.2024.06.010
35. Srivastava A, Borza T, Salami SS. Changes in the prostate biopsy landscape-how can we improve quality? Transl Androl Urol. 2025;14(4):880-2. doi: 10.21037/tau-2025-34
36. Cheng E, Davuluri M, Lewicki PJ, et al. Developments in optimizing transperineal prostate biopsy. Curr Opin Urol. 2022;32(1):85-90. doi: 10.1097/MOU.0000000000000947
37. Xiao Y, Han L, Wang H, et al. Transperineal prostate biopsy guided by which ultrasound transducer: transrectal or transperineal: a retrospective study. PeerJ. 2024;12(e18424):e18424. doi: 10.7717/peerj.18424
38. Roberts MJ, Macdonald A, Ranasinghe S, et al. Transrectal versus transperineal prostate biopsy under intravenous anaesthesia: a clinical, microbiological and cost analysis of 2048 cases over 11 years at a tertiary institution. Prostate Cancer Prostatic Dis. 2021;24(1):169-76. doi: 10.1038/s41391-020-0263-x
39. Grummet J, Gorin MA, Popert R, et al. “TREXIT 2020”: why the time to abandon transrectal prostate biopsy starts now. Prostate Cancer Prostatic Dis. 2020;23(1):62-5. doi: 10.1038/s41391-020-0204-8
40. Basourakos SP, Alshak MN, Lewicki PJ, et al. Role of prophylactic antibiotics in transperineal prostate biopsy: A systematic review and meta-analysis. Eur Urol Open Sci. 2022;37:53-63. doi: 10.1016/j.euros.2022.01.001
Article Sidebar
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain their copyright and grant the Revista Médica del IMSS the right of first publication. Articles are distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows sharing as long as the author and the original source are properly credited.