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Volume 14, Issue 2 (March 2012) 14, 310–315; 10.1038/aja.2011.130

The results of transperineal versus transrectal prostate biopsy: a systematic review and meta-analysis

Peng-Fei Shen1,*, Yu-Chun Zhu1,*, Wu-Ran Wei1, Yong-Zhong Li2, Jie Yang1, Yu-Tao Li1, Ding-Ming Li1, Jia Wang1 and Hao Zeng1

1 Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
2 Department of Ultrasonography, West China Hospital, Sichuan University, Chengdu 610041, China

* These authors contributed equally to this work.

Correspondence: Dr H Zeng, (cdhx510@126.com); Dr J Wang, (cdhx510@foxmail.com)

Received 4 July 2011; Revised 27 July 2011; Accepted 11 August 2011; Advance online publication 21 November 2011


This systematic review was performed to compare the efficacy and complications of transperineal (TP) vs. transrectal (TR) prostate biopsy. A systematic research of PUBMED, EMBASE and the Cochrane Library was performed to identify all clinical controlled trials on prostate cancer (PCa) detection rate and complications achieved by TP and TR biopsies. Prostate biopsies included sextant, extensive and saturation biopsy procedures. All patients were assigned to a TR group and a TP group. Subgroup analysis was performed according to prostate-specific antigen (PSA) levels and digital rectal examination (DRE) findings. The Cochrane Collaboration's RevMan 5.1 software was used for the meta-analysis. A total of seven trials, including three randomized controlled trials (RCTs) and four case-control studies (CCS), met our inclusion criteria. There was no significant difference in the cancer detection rate between the sextant TR and TP groups (risk difference (RD), -0.02; 95% confidence interval (CI), -0.08-0.03; P=0.34). Meta-analysis for RCTs combined with CCS showed that there was no difference in the cancer detection rate between the extensive TR and TP group (RD, -0.01; 95% CI, -0.05-0.04; P=0.81). There was no significant difference in PCa detection rate between the saturation TR and TP approaches (31.4% vs. 25.7%, respectively; P=0.3). There were also no significant differences in cancer detection between the TR and TP groups in each subgroup. Although the data on complications were not pooled for the meta-analysis, no significant difference was found when comparing TR and TP studies. TR and TP biopsies were equivalent in terms of efficiency and related complications. TP prostate biopsy should be an available and alternative procedure for use by urologists.

Keywords: prostate biopsy; prostate cancer; transperineal; transrectal

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