Transrectal (TR) and transperineal (TP) prostate biopsy approaches have similar cancer detection rates, but TP biopsies are associated with a lower rate of infection-related complications, according to investigators.

In a single-center preliminary study, Guan-Lin Huang, MD, and colleagues at Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine in Kaohsiung, Taiwan, studied 238 men who met criteria for a prostate cancer (PCa) biopsy. Of these, 130 underwent TP biopsy and 108 underwent TR biopsy, the most common prostate biopsy approach used in the United States. The TP and TR groups had similar mean ages (66.6 and 67.1 years, respectively) and similar median PSA levels (9.3 and 10.9 ng/mL, respectively).

The TP and TR groups had similar PCa detection rates (45% vs 49%, respectively), the investigators reported online in BMC Urology. In the TR group, 7.4% were hospitalized because of post-biopsy complication, 6.4% experienced sepsis, and 6.4% experienced a fever above 101.3˚ F. None of the patients in the TP group experienced these problems. A significantly higher proportion of TR than TP patients experienced urinary tract infections (12% vs 2.2%) and gross hematuria (13.8% vs 5.3%).

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“Taken together, these results suggest that patients undergoing transperineal prostate biopsy are at lower risk of post-bioptic complications,” the authors wrote.

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With regard to anesthesia, TR patients were treated with a lidocaine cream lubricant through the transrectal ultrasound puncturing hole. In the TP group, patients underwent local anesthesia (lidocaine and periprostatic nerve block) or intravenous general anesthesia.


Huang GL, Kang CH, Lee WC, Chiang PH. Comparisons of cancer detection rate and complications between transrectal and transperineal prostate biopsy approaches-a single center preliminary study [published online October 28, 2019]. BMC Urol. 2019;19:101.

doi: 10.1186/s12894-019-0539-4