BACKGROUND AND OBJECTIVE: 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. METHODS: 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). KEY FINDINGS AND LIMITATIONS: 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. CONCLUSIONS: Our findings bolster existing understanding of the additional advantages offered by TPBx. Further randomized trials to fully validate these findings are awaited. PATIENT SUMMARY: 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.

Departement of Urology Hôpital Cochin Paris France

Department of Radiology Jules Bordet Institute Erasme Hospital Hôpital Universitaire de Bruxelles Université Libre de Bruxelles Brussels Belgium

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 Clinique Saint Augustin Bordeaux France

Department of Urology Cliniques de l'Europe Saint Elisabeth Brussels Belgium

Department of Urology Grenoble Alpes University Hospital Université Grenoble Alpes Grenoble France

Department of Urology Hôpital Cavale Blanche CHRU Brest Brest France

Department of Urology Hôpital Européen Georges Pompidou Université de Paris Paris France

Department of Urology Hôpitaux Universitaires de Genève Geneva Switzerland

Department of Urology IRCCS Regina Elena National Cancer Institute Rome Italy

Department of Urology Jules Bordet Institute Erasme Hospital Hôpital Universitaire de Bruxelles Université Libre de Bruxelles Brussels Belgium

Department of Urology Klinika Wisniowa Zielona Góra Poland

Department of Urology La Croix du Sud Hospital Quint Fonsegrives France

Department of Urology University Hospital Ostrava Ostrava Czechia; Department of Surgical Studies Faculty of Medicine Ostrava University Ostrava Czechia

Department of Urology Vivantes Klinikum am Urban Berlin Germany

Citace poskytuje Crossref.org