Transperineal versus transrectal magnetic resonance imaging-fusion ultrasound-guided prostate biopsy: a comparative analysis of cancer detection in patients with prior negative transrectal ultrasound scan biopsy.

Objective: To compare and identify factors associated with prostate cancer detection between transperineal (TP) and transrectal (TR) magnetic resonance imaging (MRI)-fusion ultrasound-guided prostate biopsy in patients with a prior negative transrectal ultrasound scan (TRUS) biopsy. Methods: We retrospectively analyzed 362 patients with a prior negative TRUS-guided biopsy who underwent MRI-ultrasound fusion-guided prostate biopsy at King Chulalongkorn Memorial Hospital between 2015 and 2024 were retrospectively screened. Nineteen were excluded because of insufficient clinical or imaging data. Patients were categorized into two groups: transrectal biopsy (n = 86) and transperineal biopsy (n = 257). Cancer-detection rates, baseline characteristics, MRI parameters, and perioperative complications were compared between the two cohorts. Results: Baseline characteristics, including age, body mass index (BMI), total prostate-specific antigen (PSA), prostate volume, and PSA density, were generally comparable between the TP and TR biopsy groups, except for previous biopsy history and lesion size. The TP approach showed significantly higher detection rates for overall prostate cancer [57.2 % vs 40.7 %; odds ratio (OR): 1.95, 95 % confidence interval (CI): 1.19-3.20; Conclusion: Transperineal biopsy is the preferred approach for patients with a prior negative TRUS biopsy. Cancer detection was correlated with the transperineal approach, higher PI-RADS scores, clinical staging, and older age.