Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates

We conducted a systematic review to compare the diagnostic utility of ultrasound-guided transperineal (TP) and transrectal (TR) prostate biopsy methods for prostate cancer detection. We searched PubMed, Embase, Web of Science, and Cochrane databases up to October 30, 2023, for relevant studies, screening the literature and assessing bias independently. Eleven trials were analyzed using relative risk and 95% confidence intervals, with no evidence of publication bias. Diagnostic rates showed no significant difference between TP and TR biopsies (mean difference [MD]: 1.03, 95% confidence interval [CI]: 0.91-1.14, = 0.56). Prostate volume analysis also showed no significant difference (MD: -0.07, 95% CI: -0.73 to 0.59, < 0.0001, combined effect size = 0.83). Similarly, PSA levels were comparable between TP and TR biopsies (MD: 0.93, 95% CI: -0.44 to 2.30, < 0.0001, combined effect size = 0.18). Both biopsy methods exhibit similar diagnostic accuracy; however, TP has a lower risk of biopsy.