Which is Better: Transrectal or Transperineal Prostate Biopsy?

Prostate biopsy is a critical step in diagnosing prostate cancer. If you’ve been recommended to undertake this procedure, you may be curious about the options that are available.

Currently, the most commonly relied upon prostate biopsy method in the US is the transrectal approach. Unfortunately, this method is not perfect, and has been associated with an increasing chance of hospitalization due to infections. It also has a chance of missing lesions present in the front of the prostate.

In the past, doctors were less than keen to consider the alternative transperineal approach due to its need for general anesthesia. Luckily however, recent efforts have been made to recommend transperineal biopsies under local anesthesia as well, which could provide greater convenience and safety for patients.

If you’ve been wondering about the differences between transrectal and transperineal biopsy, this article will help provide you with a clear guide.

While both methods have a similar diagnostic accuracy, the transrectal and transperineal approaches mainly differ in terms of convenience and safety.

Advantages of the transperineal approach:

• Lower infection rates, the greatest concern associated with prostate biopsies
• Avoids transferring rectal bacteria to the prostate or bloodstream, so you would no longer need antibiotics before and after the biopsy
• Better coverage across all parts of the prostate

With minimized exposure to antibiotics, as well as bacterial transfer from the rectum to the prostate or bloodstream, this method could greatly reduce the risk of exposing you to multidrug-resistant infections, a complication commonly associated with further hospitalization.

Disadvantages of the transperineal approach:

• May need to be performed in the operating theater
• May need general or spinal anesthesia
• You may experience greater discomfort as the needle will pass through additional layers of tissue and muscles in the perineum

If you are uncomfortable with the idea of the needle passing through your perineum, you should then consider general anesthesia, or the alternative transrectal approach in this case. On the other hand, if you are keen on undergoing the procedure under local anesthesia, you will be able to avoid the costs of day admission and the short recovery period from general anesthesia.

At the end of the day, transrectal biopsy still remains the current standard test, and is widely available in most clinics under local anesthesia. If you remain keen on the transrectal approach for its convenience, rest assured that there are still measures that can be taken to minimize the risk of infection. This can include a personalized antibiotics plan based on the bacteria found in your stool, as well as an antiseptic enema, to reduce the number of bacteria in your rectum.

It may take some time for a transition to a new standard of care in prostate biopsy, especially amid differences in cost and available equipment. You may also wish to consider that as a new approach, not all institutions may have experience in conducting transperineal biopsy. Ultimately, each approach will continue to have its own fair share of advantages and disadvantages for you to consider before making your final decision.