The results of transperineal versus transrectal prostate extension biopsy: an updated systematic review and meta-analysis

Abstract This systematic review was performed to compare the current understanding of the relative efficacies and complications associated with transperineal (TP) vs. transrectal (TR) prostate biopsy. All clinical controlled trials reporting prostate cancer (PCa) detection rates and complications associated with TP and TR biopsies were systematically identified, including extensive biopsy procedures. A subgroup analysis was performed to assess the impact of certain clinical factors, e.g., prostate-specific antigen (PSA). The pooled analysis for randomized controlled trials (RCTs) combined with comparative case studies (CCSs) showed no difference in the cancer detection rate between TR and TP (risk difference (RD)=-0.01; 95% confidence interval (CI): -0.04–0.02; P = 0.37). There was no significant difference in the cancer detection rate for RCTs (RD=-0.001; 95%CI: -0.006-0.003; P = 0.55) or CCSs (RD=-0.01; 95%CI: -0.05-0.03; P = 0.59). However, more PCa was detected in the subgroup with PSA ≥ 10 ng/ml (RD = 0.07; 95%CI: 0.01–0.13; P = 0.09) and the subgroup with PSA ≥ 20 ng/ml (RD = 0.13; 95%CI: 0.05–0.20; P = 0.001) using TR biopsy across all studies, while this advantage of TR was not found in RCTs alone (RD = 0.13; 95%CI: -0.09-0.35; P = 0.24). And TP detected more PCa in patients with positive mpMRI in MRI-targeted biopsy, with an accuracy rate of 48.5% (205/423) compared to 34.2% (146/427) for the TR route (RD = 0.51; 95%CI: 0.38–0.68; P < 0.01). There was a significantly lower risk of fever (RD = 0.03; 95%CI: 0.01–0.05; P = 0.003) and rectal bleeding (RD = 0.08; 95%CI: 0.01–0.14; P = 0.02) with TP. In conclusion, there was no significant difference in the cancer detection rate between TR and TP, however, TP had advantage over TR in MRI-targeted biopsy; while TP was safer than TR, due to lower risks of fever and rectal bleeding.