Comparison between Ultrasound Guided Transperineal and Transrectal Prostate Biopsy: A Prospective, Randomized, and Controlled Trial

Abstract

This prospective study of comparing transperineal prostate biopsy (TPBx) with transrectal prostate biopsy (TRBx) was aimed to provide evidence for clinicians to select the appropriate biopsy approach under different conditions. TPBx (n = 173) and TRBx (n = 166) were performed randomly for 339 patients who were suspicious of prostate cancer (PCa). The cancer detection rate (CDR), complication rate, visual analogue scale (VAS) score, most painful procedure, number of repeated biopsy and additional anesthesia, and operating time (starting from lying down on the operating table to getting up) were recorded. The results showed that TPBx and TRBx were equivalent in CDR (35.3% vs. 31.9%) and minor complication rate (44.9% vs. 41.0%) (both P > 0.05). The major complication rate was lower in TPBx than in TRBx (0.6% vs. 4.3%, P < 0.05). TPBx was more time-consuming (17.51 ± 3.33 min vs. 14.73 ± 3.25 min) and painful (VAS score: 4.0 vs. 2.0); and it had higher rates of repeated biopsy (3.2% vs. 1.1%) and additional anesthesia (15.0% vs. 1.2%) (all P < 0.05). In summary, both TPBx and TRBx are effective to detect PCa. The major complication rate for TRBx is higher, whereas TPBx procedure is more complex and painful.

Figure 1. The protocol of TPBx. On sagittal section, both peripheral zone (PZ) and transition zone (TZ) biopsy are performed transperineally.

The depots of PPNB are apical (in the white circle with diagonals), and the routes of administration are transperineal (white dotted lines). On transverse section, for 8-core TPBx, six cores are sampled from the PZ and the other two are from the TZ (marked as white circles). For 12-core TPBx, four more cores are sampled from the PZ (marked as violet circles).

Figure 2. The protocol of TRBx.

On saggital section, it shows that TRBx is performed in three planes of prostate (base, middle and apex plane). The depots of PPNB are apical (in the white circle with diagonals), and the routes of administration are transrectal (white dotted lines). On transverse section, it shows the protocol of biopsy in each plane (two parasagittal biopsies and two far-lateral biopsies). Four cores are sampled in base plane and four in apex planes respectively for 8-core TRBx, and another four cores are sampled in middle plane for 12-core TRBx.

Figure 3. Trial profile.