Notably, transrectal biopsies detected more clinically significant prostate cancers than transperineal biopsies in small (≤1 cm) non-apical peripheral zone lesions (35% vs. 12%, adjusted OR 8.06, p = 0.017), while either approach reliably detected larger lesions. Transperineal biopsies showed a non-significant trend toward better detection in transition zone lesions, but evaluation was limited by a relatively small sample size from this location.
These findings suggest that lesion size and location may play a role in selecting a biopsy route, rather than being chosen solely based on infection risk or institutional preference. It is important to note again that this study was retrospective and thus limited in its ability to control confounders. Prospective trials are warranted to confirm these exploratory findings. Still, they suggest that the transrectal approach may offer an edge in sampling small peripheral zone targets. In contrast, the transperineal approach, based on results from previous studies, may offer similar advantages in detecting anterior and apical disease.
Written by: Quinn Rainer,1 Kemal Tuncali,1 Alexander Cole,2 Quoc-Dien Trinh,2 Kristine S. Burk,1 Mark Vangel,1 Pedro Moreira,1 Nobuhiko Hata,1 Clare Tempany,1
- Department of Radiology, Brigham and Women's Hospital, Boston, MA.
- Department of Urology, Brigham and Women's Hospital, Boston, MA.