Does a transperineal approach to prostate biopsy change your treatment plan compared to transrectal?

For example, transperineal biopsies may capture a higher volume of disease. Should this change risk stratification compared to transrectal biopsies? Is ">50% of cores" still the relevant metric? Conversely, transperineal biopsies may increase uncertainty about proximity of disease to the base of the prostate depending on how the pathologist reads the slide.

2 Answers

Mednet MemberInvited Expert

Radiation Oncology · Virginia Commonwealth University Medical Center

Answered on

The short answer is no. The typical scenario in which I have seen transperineal biopsies done is a patient with multiple negative transrectal biopsies in whom there is still a concern for clinically significant prostate cancer and an MRI has not identified a target to biopsy. In these cases, multiple biopsies were obtained throughout the prostate while the patient was under anesthesia. Under these circumstances, I don't think we really know how to factor in findings such as percent positive biopsies (generally low in these patients) or maximum core length containing cancer. Should you consider the prior negative biopsies when determining the percentage of positive cores? I've seen patients who have had over 100 negative biopsy cores taken b...

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Mednet Member

Radiation Oncology · Community Care Physicians

Answered on

It really doesn't matter TRUS vs transperineal.

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