Badar Mian discusses randomized clinical trials comparing transperineal (TP) and transrectal (TR) prostate biopsy approaches. Despite previous beliefs favoring TP biopsies for lower infection rates and better cancer detection, three major trials (ProBE-PC, PREVENT, and PERFECT) show no significant differences in sepsis rates or cancer detection between the two methods. The studies reveal similar minor infection rates requiring brief hospitalizations, with no cases of sepsis in either group. Cancer detection rates, particularly for Grade 2 or higher, are comparable between TP and TR approaches across all trials. Dr. Mian concludes that current evidence does not demonstrate clear superiority of the TP approach over TR. He notes that questions remain regarding pain levels, costs, and antibiotic prophylaxis implications for both methods. This research challenges the trend towards favoring TP biopsies and suggests a need for further evaluation of both approaches.

Biographies:

Badar Mian, MD, Urologist, Professor of Surgery, Albany Medical Center, Albany, NY

E. David Crawford, MD, Urologist, Professor of Urology, Jack A. Vickers Director of Prostate Cancer Research, University of California San Diego, San Diego Health, San Diego, CA, The University of Colorado Anschutz Medical Campus, Aurora, CO