Optimising prostate biopsy strategies: a propensity-score-matching analysis to compare the detection of prostate cancer and safety between transperineal 10-core and transrectal 12-core systematic biopsy.

[AIM] To optimise prostate biopsy strategies by comparing cancer detection rates and safety profiles between transperineal 10-core and transrectal 12-core systematic biopsy approaches.

[MATERIALS AND METHODS] In total, 903 patients who received systematic prostate biopsy between January 2017 and December 2023 were included. This cohort specifically comprised patients for whom the clinical pathway led to systematic biopsy without targeted sampling. Propensity score matching (PSM) analysis was performed to adjust for the baseline differences including age, prostate-specific antigen (PSA) level, prostate volume (PV), and PSA density (PSAD). The prostate cancer (PCa) and clinically significant PCa (csPCa) detection rates and complications were compared between the transperineal biopsy (TPB) group (n = 658) and transrectal biopsy (TRB) group (n = 245), which were stratified by clinical characteristics.

[RESULTS] After PSM, 231 patients in each group were matched in a 1:1 ratio. The TPB achieved a higher csPCa detection rate (33.8% vs 22.9%, P = 0.010) and a lower per-puncture complication rate (0.34% vs 0.79%, P = 0.039) than TRB after PSM. The csPCa detection rates in TPB were higher than those in TRB for patients with free PSA level ≤ 5 ng/ml (29.9% vs 17.7%, P = 0.024), with PV value of 25-100 ml (34.3% vs 21.9%, P = 0.049), and with PSAD value ≤ 0.6 ng/ml(24.6% vs 14.0%, P = 0.027).

[CONCLUSION] 10-core TPB was associated with a higher csPCa detection rate and lower complication risks than 12-core TRB. Nevertheless, given the elevated detection rates at specific PSA, PV, and PSAD level, it is imperative to tailor biopsy strategies in accordance with individual patient profiles to optimise outcomes.