Freehand Transperineal Prostate Biopsy Improves the Detection Rate of Clinically Significant Prostate Cancer

Objective: Freehand transperineal prostate biopsy (fTP-Bx) has been established as an alternative within the transperineal approach for prostate cancer (CaP) diagnosis. The primary objective was to compare the rate of overall CaP detection and clinically significant (greater than or equal to International Society of Urological Pathology 2) in patients with biopsy-naive between freehand transperineal prostate biopsy (fTP-Bx) and transperineal grid biopsy (TP-Bx) techniques. The secondary objective was to show the characteristics of the procedure and measure the associated complications.

Methods: A retrospective review of all patients who underwent fTP-Bx (n: 326) and TP-Bx (n: 118) in our department was conducted between October 2020 and May 2023 due to suspected CaP based on elevated prostate-specific antigen (PSA), suspicious digital rectal examination, or those under active surveillance protocol. The chisquare test and Fisher’s exact test were used to compare categorical variables.

Results: The mean age of the total cohort was 67.5 years (standard deviation 8.8). The overall CaP detection rate in the entire population was 70.1% (315/444), 73.9% for fTP-Bx and 62.7% for TP-Bx (P = .0021). The detection rate of clinically significant CaP in biopsy-naive patients was 59.7% for fTP-Bx and 45.5% for TP-Bx (P = .019). No patient required hospitalization for sepsis or had a positive culture-confirmed infection in the fTP-Bx group.

Conclusion: Freehand transperineal prostate biopsy achieved a higher rate of clinically significant CaP detection than TP-Bx in biopsy-naive patients, accompanied by a lower number of postoperative complications.

Cite this article as: Bujaldon JM, Vitagliano GJ, Blas L, Pita HR, Vocos MM. Freehand transperineal prostate biopsy improves the detection rate of clinically significant prostate cancer. Urol Res Pract.2024;50(5):269-274.