Comparative characteristics of prostate cancer detection by transperineal and transrectal fusion-biopsy

Introduction. Prostate biopsy remains the gold standard for the diagnosis of prostate cancer. In contemporary practice, increasing preference is given to fusion biopsy, which is more reliable and informative than conventional ultrasound‑guided systematic biopsy. Fusion prostate biopsy can be performed via transrectal or transperineal access, and the superiority of one approach over the other is still under investigation. Objective. To assess and compare the diagnostic performance of transrectal versus transperineal fusion prostate biopsy for the detection of prostate cancer. Materials & methods. A comparative study was conducted between October 2024 and January 2025 at St. Luke’s Clinical Hospital, Saint Petersburg. A total of 162 men with suspected prostate cancer were enrolled. Group 1 comprised 115 patients who underwent transrectal fusion prostate biopsy. Group 2 included 47 patients who underwent transperineal fusion prostate biopsy using a stabilized technique with a stepper and stabilizer. Results. In the transrectal fusion biopsy group, prostate cancer was identified in 54 cases (46.95%) on targeted cores and in 81 cases (70.4%) on standard systematic cores. Systematic cores alone detected cancer in 44 patients (38.26%), whereas targeted cores alone did so in 5 patients (4.34%); in an additional 6 patients (5.22%), targeted cores upgraded the Gleason score. Omitting systematic sampling in transrectal fusion biopsy would have reduced overall cancer detection by 38.26%, including omission of clinically significant (aggressive) disease in 9.57% of cases. In the transperineal fusion biopsy group, cancer was detected in 31 patients (65.96%) on targeted cores and in 25 patients (53.19%) on systematic cores. Targeted cores alone identified cancer in 9 cases (19.15%), whereas systematic cores contributed only 3 additional cases (6.38%), all ISUP grade group 1. Targeted sampling led to Gleason score upgrading in 4 patients (8.51%). Conclusions. For the transperineal fusion technique, omitting systematic biopsies may reduce the number of cores without materially compromising diagnostic accuracy. In contrast, for transrectal fusion biopsy, systematic sampling remains crucial, particularly for detecting aggressive cancers and improving overall diagnostic yield. These approach‑specific differences warrant further investigation to refine diagnostic pathways for prostate cancer.