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Transl Androl Urol. 2017 Jun;6(3):368-375. doi: 10.21037/tau.2017.03.58.

Transperineal vs. transrectal biopsy in MRI targeting.

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Australian Urology Associates, Melbourne, Australia.
Alfred Health, Melbourne, Australia.
Monash University, Melbourne, Australia.
Department of Urology, University Hospital Essen, Essen, Germany.


Prostate biopsy is typically performed via either the transrectal or transperineal approach. MRI-targeted biopsy, whether using any of the three options of cognitive fusion, MRI-ultrasound fusion software, or in-bore MRI-guided biopsy, can also be performed via either transrectal or transperineal approaches. As an extension of traditional random prostate biopsy, the transrectal approach is far more commonly used for MRI-targeted biopsy due to its convenience. However, in the context of today's increasing multi-drug resistance of rectal flora, the transperineal approach is being used more often due to its lack of septic complications. In addition, only a first-generation cephalosporin, not a fluoroquinolone, is required as antibiotic prophylaxis. Evidence shows excellent detection rates of significant prostate cancer using magnetic resonance imaging (MRI)-targeted and/or systematic transperineal biopsy (TPB). However, there are no head-to-head studies comparing the different MRI-targeted methods within TPB. To provide truly patient-centred care, the biopsy technique using the safest method with the highest detection rate of significant cancer should be used. Depending on healthcare context and hospital resource utilization, MRI-targeted TPB is an excellent option and should be performed wherever available and feasible. Whilst building capacity for TPB in one's practice, the routine use of rectal culture swabs prior to any transrectal biopsies is strongly encouraged. Independent of biopsy route, the addition of systematic cores needs to be discussed with the patient weighing maximal detection of significant cancer against increased detection of insignificant lesions.


Image-guided biopsy; bacterial; drug-resistance; magnetic resonance imaging (MRI); prostatic neoplasms

Conflict of interest statement

Conflicts of Interest: J Grummet: paid proctor for Biobot iSR’obot Mona Lisa, Biobot sponsored attendance at UAA ASM 2016; paid by Scanmedics for BK Ultrasound to run TPB Workshop 2014. B Hadaschik has funding from the German Research Foundation and the European Foundation for Urology and has received research support from MedCom and Uromed; none of these sources had any input into this article. The other authors have no conflicts of interest to declare.

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