Comparison between transrectal and transperineal prostate biopsy for detection of prostate cancer: a meta-analysis and trial sequential analysis

Abstract

To systematically assess the efficacy and complications of transrectal (TR) versus transperineal (TP) prostate biopsy in the detection of prostate cancer (PCa). A meta-analysis was performed by searching the databases Pubmed, Embase and Web of science for the relevant available studies until September 1st, 2016, and thirteen studies met the inclusion criteria. The pooled odds ratios with 95% confidence intervals were calculated to evaluate the differences of TR and TP groups in PCa detection rate. Then, trial sequential analysis was performed to reduce the risk of type I error and estimated whether the evidence of the results was reliable. Overall, this meta-analysis included a total of 4280 patients, who had been accrued between April 2000 and Aug 2014 and randomly divided into TR group and TP group. Prostate biopsies included sextant, extensive and saturation biopsy procedures. Patients who received TP prostate biopsy had no significant improvement in PCa detection rate, comparing TR group. Moreover, when comparing TR and TP studies, no significant difference was found in abnormal DRE findings, serum PSA level measurement, Gleason score, prostate volume. Besides, this meta-analysis showed no obvious differences between these two groups in terms of relevant complications. Therefore, this meta-analysis revealed that no significant differences were found in PCa detection rate between TP and TR approaches for prostate biopsy. However, with regard to pain relief and additional anesthesia, TR prostate needle biopsy was relatively preferable, compared to TP prostate biopsy.

Outcomes of transperineal and transrectal ultrasound-guided prostate biopsy

“…In an early report, Kojima et al 7 retrospectively assessed the usefulness of TPUSPB, which differs from TRUSPB in terms of patient position, puncture route, puncture site, and ultrasound probe. 8 Most importantly, the TPUSPB enables urologists to thoroughly prepare the perineum with a disinfectant solution to eliminate the possibility of skin flora contamination of the puncture site. 9 In addition, this procedure involves puncture of perineal skin under the guidance of a side-fire ultrasound probe without penetration of rectal mucosa, thereby avoiding the possibility that intestinal flora are transferred to the blood stream.…”

Complication Rates After TRUS Guided Transrectal Systematic and MRI-Targeted Prostate Biopsies in a High-Risk Region for Antibiotic Resistances

“…Transrectal and transperineal approaches are both safe and commonly used techniques for prostate cancer detection through prostate biopsy. The debate whether a transrectal or a transperineal approach should be performed as a gold standard with special attention to the side effects and economic reasons is still on (4,5,14,19). To evaluate the risks of transrectal TRUS-guided prostate biopsy at a university hospital with high prevalence of multidrug-resistant bacteria/organisms, complication rates were examined.…”

“…For TRUS guided prostate biopsy, a transrectal or transperineal approach is possible. Even though the cancer detection rates of both approaches are comparable, there is still an ongoing debate if a transrectal approach should be used in daily practice due to complication rates (5).…”

Prostate biopsy techniques and pre-biopsy prophylactic measures: variation in current practice patterns in the Netherlands

“…Although, in our survey, we asked urologists mainly for solutions with in the field of antimicrobial prophylaxis, it is important to note that the solution does not have to be (solely) based on the use of adapted or rectal cultureguided antimicrobial prophylaxis. Various studies found favourable infection rates for transperineal PB compared to TRUSB with similar rates of prostate cancer detection [2,[28][29][30][31]. Therefore, transperineal PB is an obvious alternative biopsy approach to avoid infections from FQ resistant bacteria.…”