Comparison of transrectal and transperineal prostate biopsy: a prospective comparative study
Background. Transrectal (TR) prostate biopsy remains the ”gold standard” but is associated with infectious risks; transperineal (TP) biopsy is considered a safer alternative with comparable diagnostic accuracy. Objective. To compare the diagnostic performance, complication rates, pain levels, and...
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ZAO "Consilium Medicum"
2025-01-01
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| author | Vladimir A. Vorobev Gadir R. Akperov Olga V. Baklanova Dmitry S. Mickevich Egor V. Kovalev Ivan P. Popov Zahir S. Azizov |
| author_facet | Vladimir A. Vorobev Gadir R. Akperov Olga V. Baklanova Dmitry S. Mickevich Egor V. Kovalev Ivan P. Popov Zahir S. Azizov |
| author_sort | Vladimir A. Vorobev |
| collection | DOAJ |
| description | Background. Transrectal (TR) prostate biopsy remains the ”gold standard” but is associated with infectious risks; transperineal (TP) biopsy is considered a safer alternative with comparable diagnostic accuracy.
Objective. To compare the diagnostic performance, complication rates, pain levels, and short-term outcomes of TR- and TP-guided prostate biopsies.
Materials and methods. A prospective randomized study included 68 men aged ≥40 years with suspected prostate cancer (PSA4 ng/mL, positive DRE, and/or PIRADS≥3). Patients were randomized into the TP group (n=53) and the TR group (n=15). A 12-core transrectal ultrasound-guided biopsy was performed with targeted sampling of PIRADS 3–5 lesions. Overall and clinically significant cancer detection rates (Gleason score ≥7), complications (Clavien–Dindo classification), pain using the Visual Analog Scale (VAS), and events within 30 days were analyzed; p0.05 was considered statistically significant.
Results. Prostate cancer was detected in 72.1% of patients: 75.5% in the TP group and 60.0% in the TR group (p=0.62). Clinically significant cancer accounted for 59.2% of cases (45.3% in TP vs 33.3% in TR; p=0.59). No Clavien grade III or higher complications or cases of urosepsis were observed. Minor complications occurred in 32.1% of TP and 40.0% of TR patients (p=0.69); low-grade fever requiring oral antibiotics (Clavien grade II) was reported only in 3.8% of TP cases. The procedure duration was longer for TP (20.6±5.2 min vs 10.3±3.8 min; p0.001) but was associated with lower pain scores (2.6±1.1 points vs 4.7±1.5 points; p0.01); 81% of TP patients rated the pain as minimal. No delayed complications were reported at 30-day follow-up.
Conclusion. Transperineal biopsy provides comparable detection of clinically significant prostate cancer, results in less procedural pain, and demonstrates an absence of severe complications, offering a safe alternative to the TR approach, particularly for patients with a higher risk of infection or difficult-to-access magnetic resonance imaging lesions. |
| format | Article |
| id | doaj-art-4b40e59269094099a7eeec99a4cd6cb5 |
| institution | Kabale University |
| issn | 2075-1753 2542-2170 |
| language | Russian |
| publishDate | 2025-01-01 |
| publisher | ZAO "Consilium Medicum" |
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| series | Consilium Medicum |
| spelling | doaj-art-4b40e59269094099a7eeec99a4cd6cb52025-08-20T03:36:18ZrusZAO "Consilium Medicum"Consilium Medicum2075-17532542-21702025-01-0127739139710.26442/20751753.2025.7.2032774962Comparison of transrectal and transperineal prostate biopsy: a prospective comparative studyVladimir A. Vorobev0https://orcid.org/0000-0003-3285-5559Gadir R. Akperov1https://orcid.org/0009-0000-6317-3898Olga V. Baklanova2https://orcid.org/0000-0002-2331-506XDmitry S. Mickevich3https://orcid.org/0000-0001-5142-9200Egor V. Kovalev4https://orcid.org/0000-0003-4789-6927Ivan P. Popov5https://orcid.org/0000-0002-9919-4129Zahir S. Azizov6https://orcid.org/0009-0002-3727-3355Bashkir State Medical UniversityRegional Oncological DispensaryIrkutsk State Medical UniversityRegional Oncological DispensaryRegional Oncological DispensaryRegional Oncological DispensaryIrkutsk State Medical UniversityBackground. Transrectal (TR) prostate biopsy remains the ”gold standard” but is associated with infectious risks; transperineal (TP) biopsy is considered a safer alternative with comparable diagnostic accuracy. Objective. To compare the diagnostic performance, complication rates, pain levels, and short-term outcomes of TR- and TP-guided prostate biopsies. Materials and methods. A prospective randomized study included 68 men aged ≥40 years with suspected prostate cancer (PSA4 ng/mL, positive DRE, and/or PIRADS≥3). Patients were randomized into the TP group (n=53) and the TR group (n=15). A 12-core transrectal ultrasound-guided biopsy was performed with targeted sampling of PIRADS 3–5 lesions. Overall and clinically significant cancer detection rates (Gleason score ≥7), complications (Clavien–Dindo classification), pain using the Visual Analog Scale (VAS), and events within 30 days were analyzed; p0.05 was considered statistically significant. Results. Prostate cancer was detected in 72.1% of patients: 75.5% in the TP group and 60.0% in the TR group (p=0.62). Clinically significant cancer accounted for 59.2% of cases (45.3% in TP vs 33.3% in TR; p=0.59). No Clavien grade III or higher complications or cases of urosepsis were observed. Minor complications occurred in 32.1% of TP and 40.0% of TR patients (p=0.69); low-grade fever requiring oral antibiotics (Clavien grade II) was reported only in 3.8% of TP cases. The procedure duration was longer for TP (20.6±5.2 min vs 10.3±3.8 min; p0.001) but was associated with lower pain scores (2.6±1.1 points vs 4.7±1.5 points; p0.01); 81% of TP patients rated the pain as minimal. No delayed complications were reported at 30-day follow-up. Conclusion. Transperineal biopsy provides comparable detection of clinically significant prostate cancer, results in less procedural pain, and demonstrates an absence of severe complications, offering a safe alternative to the TR approach, particularly for patients with a higher risk of infection or difficult-to-access magnetic resonance imaging lesions.https://consilium.orscience.ru/2075-1753/article/viewFile/678911/203996prostate cancerbiopsytransrectal approachtransperineal approachcomplicationsdiagnosis |
| spellingShingle | Vladimir A. Vorobev Gadir R. Akperov Olga V. Baklanova Dmitry S. Mickevich Egor V. Kovalev Ivan P. Popov Zahir S. Azizov Comparison of transrectal and transperineal prostate biopsy: a prospective comparative study Consilium Medicum prostate cancer biopsy transrectal approach transperineal approach complications diagnosis |
| title | Comparison of transrectal and transperineal prostate biopsy: a prospective comparative study |
| title_full | Comparison of transrectal and transperineal prostate biopsy: a prospective comparative study |
| title_fullStr | Comparison of transrectal and transperineal prostate biopsy: a prospective comparative study |
| title_full_unstemmed | Comparison of transrectal and transperineal prostate biopsy: a prospective comparative study |
| title_short | Comparison of transrectal and transperineal prostate biopsy: a prospective comparative study |
| title_sort | comparison of transrectal and transperineal prostate biopsy a prospective comparative study |
| topic | prostate cancer biopsy transrectal approach transperineal approach complications diagnosis |
| url | https://consilium.orscience.ru/2075-1753/article/viewFile/678911/203996 |
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