Ten-Year Experience Transitioning from Magnetic Resonance Imaging-Guided Transrectal to Transperineal Prostate Biopsies at a Large Single-Institution Academic Center.

INTRODUCTION

We share our 10-year experience with transitioning from MRI-fusion transrectal (TR) to MRI-fusion transperineal (TP) prostate biopsy and the increased costs and time associated with this transition, particularly from the pathology perspective.

METHODS

Our prospectively maintained MRI-fusion prostate biopsy database was queried. Demographic and clinical data were captured. The cost difference between processing TR and TP biopsies was calculated. Scenarios to decrease cost and time were explored. R-software was used for statistical analyses.

RESULTS

Over 10 years, 2370 prostate biopsies were performed (1719 TR, 651 TP). TP biopsy became the preferred method in 2023. The overall cancer detection rates (CDRs) and clinically significant CDRs (csCDRs) for TR biopsy were 55.4% (952/1719) and 35.4% (609/1719), respectively. For TP, it was 62.8% (409/651) and 41.8% (272/651), respectively. This was a significant difference in CDRs and csCDRs (P < .01). The estimated increased annual cost for TP biopsy from a pathology processing standpoint was $136,662, and the estimated time increase per year was 1332.5 hours. We constructed 4 scenarios with cost and time reductions as high as $282,750 and 2730 hours per year, respectively.

CONCLUSIONS

Transitioning to an MRI-fusion TP prostate biopsy has resulted in higher overall CDRs and csCDRs but also significantly higher costs and time spent. Possible designs may exist that could yield significant cost and time savings per annum.