Same Target, Different Tools: A Multicenter Comparison of Clinically Significant Prostate Cancer Detection Across Three MRI-Targeted Transperineal Biopsy Techniques

Objective: To compare the detection rates of clinically significant prostate cancer (csPCa) across 3 transperineal biopsy approaches: in-office local anesthetic cognitive fusion (CF), transperineal prostate biopsy (TPPB), general anesthetic CF TPPB using a brachytherapy grid, and general anesthetic software-assisted fusion (SAF) TPPB. Design, setting, and participants: We conducted a retrospective multicenter cohort study of men undergoing TPPB between April 2022 and March 2024 at 3 centers: Tauranga Hospital, New Zealand; St Andrews Hospital, Australia; and University Hospital Zurich, Switzerland. All patients underwent prebiopsy multiparametric MRI. Outcome measurements and statistical analysis: The primary outcome was the detection of csPCa (ISUP grade ≥ 2). Propensity score matching (1:1) was performed using age, body mass index (BMI), prostate-specific antigen (PSA) density, prostate volume, magnetic resonance report (PIRADS Score), and biopsy history. Logistic regression models incorporating matching weight-estimated odds ratios (ORs).The results of the matched analysis were supported by 2 sensitivity analyses: a multivariable regression in the full cohort and a matched-cohort analysis stratified by PI-RADS category (1-2, 3, and 4-5). Results: A total of 1272 patients were included (New Zealand, n = 505; Switzerland, n = 508; Australia, n = 259). After matching, csPCa detection was higher with local-anesthetic CF TPPB than with SAF TPPB (OR 0.48, 95% CI 0.34-0.69; P < .001) and general-anesthetic CF grid-based TPPB (OR 0.64, 95% CI, 0.44-0.92; P = .017). The results were consistent with those of the sensitivity analyses. Conclusions: In-office local-anesthetic cognitive-fusion TPPB was associated with higher csPCa detection than the comparator general-anesthetic cognitive-fusion and software-assisted fusion pathways in this multicenter cohort.