Transrectal versus transperineal prostate biopsy in detection of prostate cancer: a retrospective study based on 452 patients

Background: Transrectal (TR) ultrasound guided prostate biopsy and transperineal (TP) ultrasound guided prostate biopsy are the two most commonly used methods to detect prostate cancer, the detection rate of the two biopsy approaches may differ in patients with different clinical characteristics. Here we aimed to compare the prostate cancer detection rate and positive rate of biopsy cores between TR and TP prostate biopsy in patients with different clinical characteristics. Methods: We retrospectively analyzed and compared the clinical data of 452 patients underwent TR or TP prostate biopsy in our hospital from June 2017 to September 2021. And patients were stratified according to several clinical characteristic (serum PSA level, prostate volume, PSA density, PI-RADS score, T stage and ISUP grade), cancer detection rate and positive rate of biopsy cores were compared in different stratified groups. Results: There was no significant difference in age, PSA level, prostate volume, and PSA density between the TR and TP groups. TR group had a higher overall cancer detection rate and positive rate of biopsy cores than TP group. Further subgroup analysis showed that TR group had a higher cancer detection rate in patients with PI-RADS score of > 3, prostate volumes > 30 mL, and that the TR group had a higher positive rate of biopsy cores among the patients with T3-T4 stages, while TP group had a higher positive rates of biopsy cores among the patients with T1-T2 stages. Conclusions: TR approach may have advantage in patients with PI-RADS score of > 3, prostate volumes > 30 mL and T3-T4 stages, while TP approach may have advantage in patients with T1-T2 stages.