Transperineal versus Transrectal Prostate Biopsy: Comparative Analysis of Efficacy and Safety

Abstract

Prostate cancer is the most frequently diagnosed cancer in men, and systematic ultrasound-guided biopsy continues to be the standard method for diagnosis. Although the transrectal (TR) approach is commonly used, it is associated with a higher risk of infection and bleeding complications. The transperineal (TP) biopsy technique was introduced to lower these risks while preserving similar diagnostic accuracy. The purpose of this study was to evaluate and compare cancer detection rates, histopathological findings, and complication rates between transperineal (TP) and transrectal (TR) prostate biopsy methods. Four hundred and sixteen men referred for prostate biopsy at the University Multidisciplinary Hospital for Active Treatment “Tsaritsa Yoanna – ISUL” between January 2022 and December 2025 were included in the study. The patients' age ranged from 49 to 95 years (mean age 69.39 years, standard deviation – 8.365). The overall cancer detection rate was relatively similar – TR group (76.8%) vs. TP group (67.53%), while apparent differences are observed in ISUP grade. GG 1 is observed in 57% of patients in the TP group, while in the TR group, the percentage is significantly – 34%. Poorly differentiated prostate cancer (ISUP ≥ 4) is seen in 32% of patients who underwent TR biopsy, compared to 12% in the TP group.