ORIGINAL RESEARCH article
Front. Med.
Sec. Precision Medicine
Comparative Analysis of Ultrasound-Guided Magnetic Resonance Imaging-Cognitive Fusion Transrectal versus Transperineal Prostate Biopsy: A 10-year Single-center Retrospective Analysis
Provisionally accepted
- 1The First Affiliated Hospital, Anhui Medical University,, HE FEI, China
- 2The Fourth People's Hospital of Lu'an City, Lu'an, China
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Objectives: Prostate cancer (PCa) remains a leading malignancy among men worldwide. The diagnostic approach, particularly the biopsy route and integration with imaging, is crucial for accuracy. This study aimed to directly compare the diagnostic efficacy and safety of two ultrasound-guided, MRI-cognitively fused prostate biopsy approaches using a consistent extended 12+X-core sampling scheme: the transperineal (TPB) versus the transrectal (TRB) route. Methods: We conducted a comparative, retrospective analysis of 3,208 patients who underwent prostate biopsy at our institution between January 2015 and January 2024. Patients were categorized into two cohorts: a historical TRB cohort (n=1,078) from 2015–2018 and a subsequent TPB cohort (n=2,130) from 2018–2024. Crucially, both cohorts were investigated using an identical 12+X-core protocol under MRI-cognitive fusion guidance. Pathological outcomes, PCa detection rates, and perioperative complications were systematically compared. Multivariable logistic regression was employed to identify predictors of PCa detection. Results: The TPB cohort demonstrated a significantly higher overall PCa detection rate (55.73% [1,187/2,130]) compared to the TRB cohort (50.46% [544/1,078]; *p* < 0.05). Furthermore, TPB was associated with a superior safety profile, with minor complications (e.g., hematuria, low-grade fever, transient urinary symptoms) occurring in only 5.82% (124/2,130) of cases. Multivariable analysis confirmed established clinical predictors for PCa. Stratification of the detected cancers revealed that 1,701 patients (63.85%) were diagnosed with high-risk disease (Gleason score ≥8), outlining the distribution within our PCa population. Conclusion: In this comparative study, the ultrasound-guided TPB with MRI-cognitive fusion and a 12+X-core protocol demonstrated superior diagnostic efficacy and a more favorable safety profile compared to the TRB. These findings support the adoption of the TPB approach as a preferred clinical strategy for prostate biopsy.
Keywords: prostate cancer, Ultrasound-guided, Transperineal prostate biopsy, magnetic resonance imaging-cognitive fusion, complications
Received: 26 Sep 2025; Accepted: 04 Nov 2025.
Copyright: © 2025 Luo, Sun, Wang and Cheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hui Wang, wanghui_ayd@163.com
Yang Cheng, yang_cheng@ahmu.edu.cn
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