The UroOnc Minute: Transperineal vs Transrectal Prostate Biopsy, with Giancarlo Marra, MD

In this episode of The UroOnc Minute, recorded at the 41st Annual Congress of the European Association of Urology, host Adam B. Weiner, MD, connects with Giancarlo Marra, MD, of the University of Turin, Italy, to discuss a highly relevant and evolving topic in urologic oncology: transperineal vs transrectal prostate biopsy. As one of the most commonly performed procedures in both general urology and oncologic practice, biopsy approach has important implications for patient safety, resource utilization, and diagnostic performance.

Mara highlights findings from a contemporary meta-analysis¹ incorporating multiple randomized trials comparing the 2 approaches, with a particular focus on infection risk, cancer detection, and procedural considerations. The data demonstrated a consistent reduction in the risk of infectious complications with the transperineal approach, notably achieved without the need for prophylactic antibiotics (pooled odds ratio [pOR], 0.38; 95% credible interval [CrI], 0.11 to 0.90). This distinction carries meaningful implications for antibiotic stewardship and clinical workflow, as transrectal biopsy often necessitates pre-procedure cultures, targeted antimicrobial strategies, and additional coordination of care. There was no significant difference in the detection of clinically significant cancer detection (pOR, 1.01; 95% CrI, 0.65 to 1.51) or non-clinically significant prostate cancer (pOR, 1.12; 95% CrI, 0.63 to 2.18) across pooled analyses.

The discussion also addresses secondary outcomes, including urinary retention, bleeding risk, procedural time, and patient discomfort. While historical concerns have suggested higher retention rates with transperineal biopsy, contemporary data do not support a meaningful difference when modern techniques are used (pOR, 0.66; 95% CrI, 0.26 to 1.58). There is also a potential signal toward reduced bleeding requiring intervention with the transperineal approach (pOR, 0.54; 95% CrI, 0.23 to 1.14), though further validation is needed. Differences in procedure duration and pain may reflect operator experience and the learning curve associated with broader adoption of transperineal techniques.

Looking ahead, Weiner and Mara emphasize the need for continued research to better define region-specific diagnostic performance and to clarify trade-offs between procedural risks and oncologic yield. As evidence continues to evolve, this conversation underscores a growing shift toward transperineal biopsy driven by infection risk reduction and streamlined care delivery, while also acknowledging the nuances that remain in optimizing biopsy strategy for individual patients.

REFERENCE

1. Marra G, Bazzurro F, Dematteis A, et al. Transperineal Versus Transrectal Biopsy for Prostate Cancer Diagnosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol Oncol. 2026:S2588-9311(26)00030-1. doi:10.1016/j.euo.2026.01.009