Advancing Prostate Cancer Diagnostics: Retrospective Insights Into Transperineal Biopsy as a Primary Approach

Introduction Transperineal (TP) prostate biopsy offers several advantages over transrectal (TR) prostate biopsy, including a reduced risk of infection and improved accessibility to hard‐to‐reach areas of the prostate. This retrospective study aims to present our clinical experience and compare the outcomes of TP and TR prostate biopsy methods. Materials and Methods We retrospectively analyzed patients who underwent TP or TR prostate biopsy between January 2024 and September 2024 at the Department of Urology, Manisa Celal Bayar University Hospital. A total of 40 patients underwent TP biopsy, and 40 patients underwent TR biopsy. Data extracted included prostate‐specific antigen (PSA) levels, prostate size, Prostate Imaging Reporting and Data System (PI‐RADS) scores obtained from multiparametric magnetic resonance imaging (mpMRI), pain scores, postprocedural complications (e.g., infection, lower urinary tract symptoms LUTS, and hematuria), and pathological outcomes such as overall cancer detection rates and the percentage of cancerous nuclei. Results In the TP biopsy group, cancer was detected in 62% of patients, compared to 45% in the TR biopsy group. Concordance between MRI imaging findings and pathology was observed in 57% of the TP group, whereas this rate was 40% in the TR group. Regarding complications, no infections were reported in the TP group, while hematuria occurred in 7% and LUTS in 17%. In the TR group, infection occurred in 7%, hematuria in 10%, and LUTS in 5% of patients. Pain scores during the procedure differed between the groups. In the TP group, the highest pain score was 4, and the most commonly reported score was 2. During probe insertion, the pain score was most frequently 2, with a maximum of 4. In the TR group, the highest pain score during the procedure was 5, and the most common score was 3. During probe insertion, the most frequent score was 3, with a maximum score of 4. Conclusion These findings highlight the advantages of TP biopsy, including a higher diagnostic yield, lower complication rates, and better patient‐reported satisfaction. Therefore, TP biopsy should be considered the primary method for prostate biopsies in clinical practice.