Transperineal biopsy doubles prostate cancer detection vs transrectal in PI-RADS 3–4

In a retrospective cohort, transperineal (TP) prostate biopsy yielded a 55.4% cancer detection rate vs 27.4% for transrectal (TR) in men with elevated PSA and PI-RADS 3-4 lesions (P=0.001), with no increase in adverse events. Findings require prospective validation.

• Single-center retrospective cohort of 127 patients (65 TP, 62 TR) with elevated PSA and PI-RADS 3-4 MRI findings.
• No significant differences in adverse events (fever, infection, rectal bleeding) or routine labs between groups.
• Non-randomized design with protocol differences between groups limits causal inference; single-center.

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