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  • Review Article
  • Published:

Transperineal biopsy of the prostate—is this the future?

Nature Reviews Urology volume 10, pages 690–702 (2013)Cite this article

Subjects

Key Points

  • Transperineal prostate biopsy provides better anteroapical sampling than transrectal ultrasonography (TRUS)-guided biopsy, leading to improved cancer detection rates

  • Although usually used as a confirmatory test after negative TRUS-guided biopsy, transperineal biopsy shows promise as an initial investigation

  • Transperineal biopsy frequently requires higher levels of anaesthesia relative to TRUS-guided biopsy, especially when >10–12 cores are taken

  • In patients at high risk of infection (such as those with diabetes mellitus or who recently travelled to countries with high prevalence of antimicrobial resistance), transperineal biopsy is safer than TRUS-guided biopsy in terms of reducing sepsis

  • Multiparametric MRI technology improves the cancer detection rate and accuracy of disease grading in needle biopsy and enables targeted biopsy, which reduces the risk of complications

Abstract

Transperineal prostate biopsy is re-emerging after decades of being an underused alternative to transrectal biopsy guided by transrectal ultrasonography (TRUS). Factors driving this change include possible improved cancer detection rates, improved sampling of the anteroapical regions of the prostate, a reduced risk of false negative results and a reduced risk of underestimating disease volume and grade. The increasing incidence of antimicrobial resistance and patients with diabetes mellitus who are at high risk of sepsis also favours transperineal biopsy as a sterile alternative to standard TRUS-guided biopsy. Factors limiting its use include increased time, training and financial constraints as well as the need for high-grade anaesthesia. Furthermore, the necessary equipment for transperineal biopsy is not widely available. However, the expansion of transperineal biopsy has been propagated by the increase in multiparametric MRI-guided biopsies, which often use the transperineal approach. Used with MRI imaging, transperineal biopsy has led to improvements in cancer detection rates, more-accurate grading of cancer severity and reduced risk of diagnosing clinically insignificant disease. Targeted biopsy under MRI guidance can reduce the number of cores required, reducing the risk of complications from needle biopsy.

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Figure 1: Comparison of transperineal and transrectal approaches to prostate biopsy.
Figure 2: Modern transperineal biopsy scheme.

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Authors and Affiliations

  1. Fremantle Hospital and Health Service, Alma Street, Fremantle, 6160, WA, Australia

    Dwayne T. S. Chang

  2. Department of Urology, Guy's Hospital, London, SE1 9RT, UK

    Benjamin Challacombe

  3. Department of Surgery and Ludwig Institute for Cancer Research, University of Melbourne, Austin Hospital, Suite 5, 210 Burgundy Street, Heidelberg, 3084, VIC, Australia

    Nathan Lawrentschuk

Authors
  1. Dwayne T. S. Chang
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  2. Benjamin Challacombe
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  3. Nathan Lawrentschuk
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All authors researched the data for the article, discussed its content, wrote the manuscript and edited it before submission.

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Correspondence to Nathan Lawrentschuk.

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The authors declare no competing financial interests.

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Chang, D., Challacombe, B. & Lawrentschuk, N. Transperineal biopsy of the prostate—is this the future?. Nat Rev Urol 10, 690–702 (2013). https://doi.org/10.1038/nrurol.2013.195

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