The Evolution of Prostate Biopsy: A Retrospective Comparison of Transperineal and Transrectal Approaches Under Local Anaesthesia

Background and objective First-line tissue sampling for prostate cancer can be performed using either transrectal ultrasound biopsy (TRUS) or local anaesthetic transperineal biopsy (LATP). The aim of this study is to compare these two techniques, examining outcomes of procedure tolerability, complications and cancer detection rate. Methods A retrospective, single-centre cohort study of patients undergoing prostate biopsy was performed. A telephone questionnaire was completed 72 hours post-biopsy, focusing on pain scores and complications. Cancer detection rates were also recorded. Results This study included 110 patients (55 LATP, 55 TRUS). Clinical data examining age, digital rectal examination findings, prostate-specific antigen (PSA), PSA density, prostate volume and prostate imaging reporting and data system (PI-RADS) score were gathered. Tolerability in both LATP and TRUS was similar. The median pain score on ultrasound probe use and biopsy gun deployment was marginally higher in the TRUS group. Difficulty passing urine occurred in 9% of LATP and 16% of TRUS (p=0.3916). Haematuria was seen in 58% of LATP and 73% of TRUS (p=0.1600). No patient required hospital admission. Cancer detection rates for LATP versus TRUS were 58.2% and 47.3%, respectively, (p = 0.3397) with higher LATP detection also seen in isolated PI-RADS 4/5 cases (p=0.2270). No statistically significant difference was found in detection rates or complications. Conclusion LATP is safe when compared to TRUS in all aspects of procedure tolerability, complications, and cancer detection rate.