Superior cancer detection with transperineal biopsy in patients with an elevated prostate-specific antigen level and a PI-RADS score of 3-4: A retrospective cohort study.

The early and accurate detection of prostate cancer remains pivotal for improving clinical outcomes. The present study aimed to compare the cancer detection rates (CDRs) and safety profiles of transperineal (TP) vs. transrectal (TR) prostate biopsy techniques in patients with elevated prostate-specific antigen (PSA) levels and magnetic resonance imaging findings suggestive of malignancy (Prostate Imaging Reporting and Data System score 3 or 4). A retrospective cohort study was conducted on 127 patients who underwent TP (n=65) or TR (n=62) prostate biopsies between May 2022 and August 2024. CDR, adverse events and laboratory findings were compared between the groups. The TP approach yielded a significantly higher CDR (55.38%) than the TR approach (27.42%) (P=0.001), with no increase in adverse events, such as fever, infection or rectal bleeding. Routine lab values, including those for PSA and free PSA, showed no significant differences. In conclusion, in the present retrospective single-center cohort, the TP protocol used was associated with a higher cancer detection rate than the TR protocol, without an increased rate of adverse events. Given the non-randomized design and protocol differences between groups, these findings should be interpreted with caution and warrant confirmation in prospective multicenter studies.