Optimization of Prostate Adenocarcinoma Diagnostics: Comparative Analysis of Transperineal and Transrectal Core Needle Biopsy – Experience of the Onco-Urology Department of MNE "OCC" (2025–2026)

Abstract

Diagnosis of prostate cancer (PCa) requires high-precision verification to select an adequate treatment strategy. Despite the widespread use of transrectal biopsy (TRB), the risks of infectious complications and limited accessibility of the anterior zones of the prostate necessitate a shift toward the "gold standard" – transperineal (perineal) trephine biopsy (TPB). Aim. To analyze the results of implementing transperineal biopsy in the clinical practice of the Oncourology Department of the "RCO" (Regional Clinical Oncology Center) and to evaluate its advantages in complex clinical cases. Materials and Methods. During the period of 2025–2026, 860 ultrasound-guided prostate biopsies were performed. The study was based on a multiparametric approach: 91.8% of patients (n=790) underwent multiparametric MRI with intravenous contrast. Inclusion criteria were PSA > 3.0 ng/mL and Pi-RADS 4–5 scores. BK ProFocus 2202 with a biplane transducer and Mindray DC-N3 ultrasound systems were utilized. Procedures were performed under local periprostatic block (1% lidocaine). A specific feature of TPB was the use of a Foley catheter for urethra visualization and the complete omission of antibiotic prophylaxis. Results. A total of 815 cases of acinar adenocarcinoma were detected. TPB demonstrated critical importance as the method of choice for suspected anteriorly located tumors and as a "rescue method" following negative TRB (80% success rate in repeated verification). The study details a clinical case of a 51-year-old patient with a history of multifocal synchronous colorectal cancer and comorbid diabetes mellitus. Due to the surgically altered anatomy of the rectum, TPB served as the only viable diagnostic method, enabling the detection of aggressive adenocarcinoma (Gleason score 9, High-risk). Conclusions. Transperineal biopsy provides higher diagnostic accuracy for localized forms of PCa, minimizes the risk of sepsis, and remains the only alternative for patients with rectal pathologies. A differentiated choice of access depending on the stage and localization of the process optimizes the workflow of an oncourological hospital and increases the detection rate of cancer at early stages.