Prostate biopsy remains the gold standard approach to verify prostate cancer diagnosis. Transrectal (TR) biopsy is a regular modality, while transperineal (TP) biopsy is an alternative for the patients who display persistently high levels of prostate-specific antigen (PSA) and thus have to undergo repeat biopsy. This study aimed to compare the cancer detection rates between TR and TP approaches and assess the post-bioptic complications of the two procedures. Besides, the feasibility of performing TP biopsies under local anesthesia was also evaluated. A total of 238 outpatient visits meeting the criteria for prostate cancer biopsy were enrolled for this study. They were divided into two groups: the TP group (n = 130) consists of patients destined to undergo local anesthetic TP biopsy; and the TR group (n = 108) contained those who received TR biopsy as comparison. Age, PSA level, digital rectal exam (DRE) finding, prostate volume, and biopsy core number were used as the parameters of the multivariable analyses. The comparable items included cancer detection rate, complication rate, admission rate and visual analog scale (VAS) score. The cancer detection rates between TP and TR groups were quite comparable (45% v.s. 49%) (p = 0.492). However, the TP group, as compared to the TR group, had significantly lower incidence of infection-related complications (except epididymitis and prostatitis) that commonly occur after biopsies. None of the patients in the TP group were hospitalized due to the post-bioptic complications, whereas there was still a minor portion of those in the TR group (7.4%) requiring hospitalization after biopsy. Medians (25–75% quartiles) of visual analog scale (VAS) were 3 [3, 4] and 4 [3–5] respectively for the TP and TR procedures under local anesthesia, but no statistical significance existed between them (p = 0.085). Patients receiving TP biopsy are less likely to manifest infection-related complications. Therefore, TP biopsy is a more feasible local anesthetic approach for prostate cancer detection if there are concerns for infectious complications and/or the risk of general anesthesia.

中文翻译：

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经直肠和会阴前列腺活检方法之间的癌症检出率和并发症的比较-单中心初步研究

前列腺活检仍是验证前列腺癌诊断的金标准方法。经直肠（TR）活检是常规方式，而经会阴（TP）活检是表现出持续高水平前列腺特异性抗原（PSA）并因此必须进行重复活检的患者的另一种选择。这项研究旨在比较TR和TP方法之间的癌症检出率，并评估两种手术的活检后并发症。此外，还评估了在局部麻醉下进行TP活检的可行性。这项研究共纳入238位符合前列腺癌活检标准的门诊患者。他们分为两组：TP组（n = 130）由预定进行局部麻醉性TP活检的患者组成。TR组（n = 108）包含接受TR活检的患者作为比较。年龄，PSA水平，直肠指检（DRE）发现，前列腺体积和活检核心数均用作多变量分析的参数。可比项目包括癌症检出率，并发症发生率，入院率和视觉模拟量表（VAS）评分。TP组和TR组之间的癌症检出率相当（45％比49％）（p = 0.492）。但是，与TR组相比，TP组的感染相关并发症（附睾炎和前列腺炎除外）的发生率显着降低，这些并发症通常在活检后发生。TP组没有因活检后并发症而住院，而TR组中只有一小部分（7.4％）活检后需要住院。局部麻醉下TP和TR程序的视觉模拟量表（VAS）的中位数（25-75％四分位数）分别为3 [3、4]和4 [3-5]。 0.085）。接受TP活检的患者不太可能出现感染相关的并发症。因此，如果担心感染并发症和/或全身麻醉的风险，TP活检是用于前列腺癌检测的更可行的局部麻醉方法。