Comparison of Outcomes with Transperineal Versus Transrectal Image-Targeted Prostate Biopsy

It is essential that prostate biopsy is safe, accessible, and accurately diagnoses clinically significant prostate cancer. Multiparametric magnetic resonance imaging has revolutionised the workup of prostate cancer, by not to allow clinicians to avoid an unnecessary biopsy when negative but also to visualise and subsequently target lesions on biopsy. Biopsy cores may be obtained via either the transrectal or transperineal approach. Transrectal biopsy has been the traditional approach, but accumulating evidence has shown advantages for the TP route. Here, we compare the outcomes between two routes in the image-targeted population, including detection of clinically significant cancer, complications, and access/costs. We conclude that although the level of evidence is low, there may be advantages in both the diagnostic accuracy (especially in apical and anterior tumours) of clinically significant cancer and the rates of infection with the transperineal approach. Several large, randomised control trials are underway to either support or disprove this.