Breaking: Transperineal biopsies find more prostate cancer, but also cause patients more pain and embarrassment

New Research Shows Transperineal Biopsies Detect More Prostate Cancer

TRANSLATE Trial Adds to Growing Evidence in Biopsy Approach Debate

Recent research has shed new light on the ongoing debate between transperineal (TP) and transrectal (TR) prostate biopsy approaches. The TRANSLATE trial, presented at the European Association of Urology Annual Congress in Madrid last month, represents the largest randomized study of its kind with 1,126 participants.

Led by Dr. Richard Bryant from the University of Oxford, the research found that the local anesthesia transperineal (LATP) approach detected 5.7% more clinically significant prostate cancers (Grade Group 2 or higher) compared to the transrectal ultrasound (TRUS) approach. Dr. Bryant emphasized that cancer detection is the primary goal of prostate biopsies, making this finding particularly significant.

"I've always said that a man doesn't have a biopsy to avoid an infection," Dr. Bryant noted in an interview. "A man has a biopsy to either find, or hopefully not find in his case, clinically significant prostate cancer that needs treatment."

Dr. Jim Hu from Weill Cornell suggested the improved detection rates may be because LATP "inherently samples more of the prostate's peripheral zone" and captures more of the transition zone in smaller prostates.

The study also found fewer infection-related hospitalizations in the LATP group at 35 days post-procedure (2 patients) compared to the TR group (9 patients). Additionally, 88% of LATP patients safely underwent the procedure without antibiotics, an important consideration for antibiotic stewardship.

However, the TRANSLATE researchers reported that patients experienced more pain and embarrassment with the LATP approach (36%) compared to TRUS (27%). Dr. Richard Szabo from UC Irvine suggested this might be related to the brief exposure of genitals during the TP procedure setup.

This research adds to a growing body of evidence from four major randomized trials published in the past year. Dr. Badar Mian from Albany Medical College, who led one of these trials, observed that the differences in outcomes across studies have been smaller than initially expected.

"The fractional differences in these outcomes, which are also not consistent across the studies, prevent us from favoring one procedure over the other," Dr. Mian said. "It's time to shift our focus from picking a winner to instead focus whether prostate biopsy procedures are safe and effective."

Not everyone agrees with this neutral stance. Dr. Jeremy Grummet, a leader in the "TRexit" movement advocating for abandoning TR biopsies, emphasized that "transperineal biopsy is the standard of care across Australia" and that post-biopsy sepsis has "happily disappeared from our practice" as a result.

What This Means for Patients

For men facing a prostate biopsy, these findings suggest both approaches can be performed safely, but the LATP approach may offer advantages in cancer detection and reduced infection risk. Patients should discuss both options with their urologist, considering factors such as:

  • Cancer detection rates
  • Infection risks
  • Need for antibiotics
  • Pain management options
  • Local provider expertise with each technique

Dr. Declan Murphy, a prostate cancer specialist at the Peter MacCallum Cancer Centre in Australia, summed up the current state of the debate: "Cancer detection trumps infection, and what we've seen here from [Bryant et al.] is that cancer detection rate is inferior in the best-powered trial we have to date. And we know that to make prostate biopsy safe transrectally, we must use antibiotics."

The American Urological Association currently gives equal preference to both approaches in its 2023 guidelines, which are scheduled for review in 2026. This new research may influence future recommendations.

Sources:

  1. The Active Surveillor: "Breaking: Transperineal biopsies find more prostate cancer, but also cause patients more pain and embarrassment" by Howard Wolinsky, March 31, 2025. [newsletter]
  2. Lancet Oncology: "Transperineal versus transrectal prostate biopsy for cancer detection in biopsy-naïve patients (the TRANSLATE trial): a multicentre, randomised, superiority trial" by Richard Bryant et al., 2025. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)30086-9/fulltext
  3. European Association of Urology Annual Congress, Madrid, March 2025. https://eaucongress.uroweb.org/
  4. PRoBE-PC Trial: "Prospective Randomized Trial of Transrectal versus Transperineal Prostate Biopsy for Detection of Prostate Cancer" by Badar Mian et al., 2024. https://www.auajournals.org/doi/10.1097/JU.0000000000003480
  5. PREVENT Trial: "A Single-blinded Randomized Controlled Trial Comparing Infection-related Complications Between Transperineal and Transrectal Prostate Biopsy" by Jim Hu et al., 2024. https://www.europeanurology.com/article/S0302-2838(23)02808-7/fulltext

Breaking: Transperineal biopsies find more prostate cancer, but also cause patients more pain and embarrassment

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