A retrospective study at a single U.S. center compared two prostate biopsy methods: local anesthetic transperineal biopsy and transrectal ultrasound biopsy.
Both techniques achieved 100% procedural completion with no severe complications or hospital admissions. Pain during ultrasound probe insertion and biopsy gun deployment was significantly higher in the transrectal group.
Urinary difficulty occurred in 9% of transperineal patients versus 16% transrectal; hematuria in 58% versus 73%. One mild urinary tract infection occurred in the transrectal group.
Cancer detection was 58.2% with transperineal biopsy versus 47.3% with transrectal-rising to 81.4% versus 64.2% in high-suspicion PI-RADS 4-5 lesions. All transperineal patients said they would repeat the procedure; most with prior biopsy experience rated it superior.
The authors conclude transperineal biopsy under local anesthesia is safe, better tolerated, and shows promising diagnostic performance-warranting larger multicenter validation.