Prostate cancer, a significant male health concern (ASR: 29.3/100,000), demands accurate diagnosis. Prostate biopsy, pivotal for clinical decisions, relies on transrectal biopsy as the norm, despite limitations like infection risk and incomplete sampling. An alternative, transperineal biopsy, grants broader access but demands more time and anesthesia. Escalating complications due to antibiotic resistance heighten apprehensions. Discrepancies in complications emerge from varied studies, while cancer detection rates stay consistent (45-49%). These conflicting outcomes raise vital safety issues. This study strives to bridge the information void by assessing complications within the local context, offering clarity for informed biopsy choices. With 150 words, the importance of evaluating biopsy methods in light of complications becomes evident, emphasizing the significance of this research in guiding clinical practice.

This research aims to compare ultrasound guided transrectal prostate biopsy and freehand ultrasound guided transperineal biopsy at a Quezon City government hospital. Specific objectives include describing patient profiles for each technique, assessing infection rates, evaluating pain tolerance, comparing hematuria levels, measuring dysuria immediately post-biopsy and 1 day after, analyzing hospitalization rates, evaluating the techniques’ effectiveness in detecting prostate cancer, and reviewing histopathologic differences in prostatitis between the two methods.

The study was conducted at the Veterans Memorial Medical Center Urology Section from January to October 2023. Using a prospective, descriptive, cross-sectional design, male patients undergoing ultrasound guided transrectal or transperineal prostate biopsies were included. Inclusion criteria include males aged 45 and above with PSA above 4.0 ng/dl and abnormal prostate findings. Exclusion criteria cover repeat biopsy cases and prior prostate cancer diagnosis. With an assumed 50% detection and complication rate, a minimum of 109 patients for each biopsy type was required for a 95% confidence level and 5% margin of error, totaling 218 participants.

The study compared transrectal and transperineal prostate biopsies in terms of patient characteristics, complications, diagnostic accuracy, and cancer detection rates. Patients undergoing transrectal biopsy had higher mean PSA levels (53.41 vs. 28.59, p=0.024) and received more fosfomycin prophylactic antibiotics (27% vs. 18%, p=0.044) compared to transperineal biopsy patients. Complication rates varied significantly between the two techniques, with chronic prostatitis seen in 5% of transperineal cases (p < 0.01). Transrectal biopsy patients experienced more pain, gross hematuria, urinary retention, fever, and hospitalization (p < 0.01). Diagnostic performance, assessed through the ROC curve’s area under the curve, showed comparable sensitivity and specificity for transrectal (AUC=0.559) and transperineal (AUC=0.441) biopsies (p=0.108). Cancer detection rates did not significantly differ between transrectal (34.4%) and transperineal (45.9%) biopsies (p=0.114). These results provide insights into the differences and similarities between the two biopsy techniques, impacting patient demographics, complications, and diagnostic outcomes.

This comparative investigation of transrectal and transperineal prostate biopsies in a tertiary hospital setting yields impactful insights. Participant ages were similar, but transrectal patients had higher PSA levels. Complication rates varied, with more chronic prostatitis in the transperineal group. Transperineal biopsies reduced pain, while transrectal group faced more complications. Cancer detection rates remained comparable. Transperineal biopsies demonstrated advantages in alleviating discomfort and potentially reducing complications. Tailoring biopsy approach based on patient profiles is crucial for diagnostic efficacy and patient well-being. These findings guide informed decision-making, prioritizing safety and experience in prostate biopsy practices.