Transrectal vs transperineal prostate biopsy: a systematic review and meta‐analysis

OBJECTIVE: To compare transrectal ultrasonography (TRUS) and local anaesthetic transperineal (LATP) biopsy. METHODS: A systematic review of randomised control trials and prospective studies meeting eligibility criteria was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: A total of 12 studies with 8497 patients were included. LATP biopsy was performed in 3961 patients and TRUS biopsy in 4536. Patient characteristics were comparable in both groups. Infection (risk ratio [RR] 0.68, 95% confidence interval [CI] 0.56-0.84, P < 0.001) and sepsis rates were significantly lower in the LATP group (RR 0.16, 95% CI 0.08-0.33, P < 0.001) and urinary retention rates were comparable (RR 0.87, 95% CI 0.61-1.25, P = 0.46). Overall cancer detection rates were significantly higher in LATP biopsy (RR 1.07, 95% CI 1.03-1.10, P < 0.001) as were Gleason Grade Group 2-5 or clinically significant cancer detection rates (RR 1.12, 95% CI 1.06-1.18, P < 0.001). Gleason GG 1 detection rates were comparable (RR 0.92, 95% CI 0.82-1.04, P = 0.20). CONCLUSION: The LATP biopsy is associated with lower rates of infection and sepsis compared to TRUS biopsy. The LATP biopsy also detects a higher overall incidence of prostate cancer and clinically significant prostate cancer (Gleason Grade Group 2-5).