Impact of Approach Routes in MRI-Ultrasound Fusion Prostate Biopsy on Post-Biopsy Complications: A Propensity Score-Matched Analysis.

objectivesThis study aimed to assess the association between post-biopsy complications and approach routes in MRI-ultrasound fusion biopsy (FB) using propensity score-matched analysis to adjust for patient background characteristics.

methodsThis retrospective study included 778 FB-naïve patients who underwent FB for suspected prostate cancer between June 2017 and November 2022. Patients were consecutively assigned to transrectal FB (TR-FB) and transperineal FB (TP-FB) groups. Propensity score matching was performed to adjust for age, prostate volume, number of targeted lesions, diabetes, pre-existing pyuria, and the use of antithrombotic drugs between the groups. Post-biopsy complications, including hematuria, acute prostatitis, urinary retention, and rectal bleeding, were graded according to the Common Terminology Criteria for Adverse Events version 5.0, and the incidence rates were compared. Multivariable analysis was performed to explore the risk factors for grade ≥ 2 acute prostatitis.

resultsOverall, 427 and 351 patients underwent TR-FB and TP-FB, respectively. In the matched cohort, grade ≥ 2 acute prostatitis occurred significantly more frequently in the TR-FB group than in the TP-FB group (3.4% vs. 0.3%, p = 0.006). A similar difference was observed in grade 3 acute prostatitis (2.2% vs. 0.0%, p = 0.015). No significant differences were observed in any other complications. Multivariable analysis identified the TR approach (odds ratio [OR] 12.11, p = 0.018) and use of antithrombotic drugs (OR 5.07, p = 0.018) as independent risk factors for grade ≥ 2 acute prostatitis.

conclusionTP-FB was associated with a significantly lower risk of acute prostatitis than TR-FB, suggesting that the transperineal approach should be considered from a safety perspective.