Single-Center Comparative Evaluation of Freehand Transperineal and Transrectal Prostate Biopsy Techniques Performed Under Local Anesthesia

Abstract

Background: To diagnose prostate cancer, a prostate biopsy is required. Two methods are commonly used for biopsy: transrectal and transperineal. The transperineal approach, particularly the "freehand" technique under local anesthesia, offers better access to the anterior prostate, lower infection risk, and higher detection rates. Methods: This retrospective study examined the records of 1674 patients who underwent ultrasound-guided prostate biopsies between 2015 and 2022. Of these, 1161 patients had transperineal biopsy using the "freehand" method, and 513 had transrectal biopsy. All the biopsies were carried out under local anesthesia, with a combined systematic and targeted approach for patients with MRI-identified lesions. Results: This study demonstrates that the transperineal biopsy approach significantly increased the detection rate of clinically significant prostate cancer compared with the transrectal method, with detection rates of 65.7% and 59.4%, respectively. Notably, the transperineal technique also achieved superior detection of anteriorly located tumors (94.1% vs. 43.1%), supporting its use as the preferred biopsy strategy, particularly in anatomically challenging regions. Moreover, patients who underwent transperineal biopsy demonstrated more favorable diagnostic outcomes, characterized by a higher detection rate for clinically significant cancers and a reduced incidence of clinically insignificant cases. The transperineal method outperformed the transrectal approach, especially among younger patients and those presenting with lower PSA values. These results highlight the diagnostic superiority and broader clinical applicability of the transperineal biopsy technique across various patient subgroups.

Keywords: detection rate; local anesthesia; prostate biopsy; prostate cancer; transperineal; transrectal.