A comparison of the diagnostic value of transrectal and transperineal prostate biopsies for prostate cancer

Abstract:

Objective To compare the difference in the detection rate of prostate cancer（PCa） between ultrasound-guided transrectal prostate systematic biopsy（TR-SB） and magnetic resonance/ultrasound-guided transperineal prostate targeted biopsy（TP-TB），and to evaluate the diagnostic value of both methods.Methods A retrospective analysis was conducted on 310 patients who underwent transrectal and transperineal prostate biopsies in the First Affiliated Hospital of Chongqing Medical University from December 2020 to May 2022. The patients were divided into TR-SB group and TP-TB group based on the biopsy methods. The two biopsies were compared for the differences in the detection rates of PCa and clinically significant prostate cancer（CSPCa），as well as the incidence of complications.Results There was no significant difference in the detection rates of PCa and CSPCa between the TR-SB and TP-TB groups in patients with a total prostate-specific antigen（tPSA） level of 4-50 ng/mL（P>0.05）. The detection rates of PCa and CSPCa were significantly higher in the TP-TB group than in the TR-SB group when the tPSA level was between 4-<10 ng/mL or 10-<20 ng/mL and the free/total prostate-specific antigen（f/tPSA） level was less than 0.16（P<0.05）. The detection rate of CSPCa was significantly higher in the TP-TB group than in the TR-SB group when the tPSA level was between 10-<20 ng/mL（P<0.05）. There was no significant difference in the overall incidence of complications between the two groups（P>0.05）. The risk of postoperative fever and infections was significantly higher in the TR-SB group than in the TP-TB group（P<0.05）.Conclusion TS-TB has a higher detection rate for PCa and CSPCa in patients with a tPSA level of 4-<10 ng/mL or 10-<20 ng/mL and an f/tPSA level of less than 0.16. For patients with a tPSA level of 10-<20 ng/mL，especially accompanied by an f/tPSA level of less than 0.16，TP-TB has a higher detection rate for highly invasive CSPCa and has a lower risk of postoperative infections，making it an efficient and safer biopsy method in clinical practice.