Giannakodimos Ilias, Kaltsas Aris, Moulavasilis Napoleon, Kratiras Zisis, Mitropoulos Dionysios, Chrisofos Michael, Stravodimos Konstantinos, Fragkiadis Evangelos
Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece.
Department of Urology, Laikon General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.
J Clin Med. 2025 Jan 12;14(2):453. doi: 10.3390/jcm14020453.
: Multiparametric-Magnetic Resonance Imaging(mp-MRI) presents the ability to detect clinically significant cancer, aiming to avoid biopsy if the results are negative or target an abnormal lesion if a suspected lesion of the prostate is found. Recent guidelines recommend the performance of 12 standard biopsies along with 3 to 5 targeted biopsies in suspected prostate lesions, depending on the size of the prostate lesion. In addition, prostate biopsy can be performed by either the transperineal or the transrectal approach. The aim of this comprehensive review is to highlight the role of both standard and targeted MRI/Ultrasound (US) fusion transperineal biopsy (TPB) in the diagnostic approach of prostate cancer cases, to report its diagnostic efficacy and complication rates and to suggest the promising usage of MRI/US fusion TPB in the future. A comprehensive review of the existing literature, including systematic reviews, meta-analyses, and clinical guidelines, was conducted to compare the efficacy and safety of transperineal and transrectal approaches in prostate cancer detection. Special emphasis was placed on mp-MRI-guided targeted biopsy and its combination with systematic sampling. Prostate biopsy via the transperineal approach is related to increased detection rates, especially for anterior lesions, and decreased infection risk compared to the transrectal approach, while complication rates (hematuria, hemospermia, etc.) remain similar. Due to lower infection rates via the transperineal route, the performance of prostate biopsy using the transperineal approach is strongly recommended. Finally, transperineal fusion MRI/US biopsy can be valuable for repeat biopsies in patients who had an initial negative biopsy or for the follow-up of patients that undergo active surveillance. MRI/US fusion-guided TPB represents a significant advancement in prostate cancer diagnostics, combining improved precision with reduced infection risks. Although TPB presents higher detection rates for anterior prostatic lesions and lower post-biopsy infection rates, there is no significant difference in cancer detection rates compared to TRB. Targeted training and investment may reduce long-term expenses of TPB by lowering hospitalizations, antibiotic usage, and related costs. Future research should further refine this approach and explore its integration with emerging technologies like artificial intelligence for enhanced lesion targeting and diagnostic accuracy.
多参数磁共振成像（mp-MRI）具有检测具有临床意义的癌症的能力，旨在如果结果为阴性则避免进行活检，或者如果发现前列腺可疑病变则针对异常病变进行活检。最近的指南建议，根据前列腺病变的大小，对可疑前列腺病变进行12次标准活检以及3至5次靶向活检。此外，前列腺活检可通过经会阴途径或经直肠途径进行。本综述的目的是强调标准和靶向MRI/超声（US）融合经会阴活检（TPB）在前列腺癌病例诊断方法中的作用，报告其诊断效能和并发症发生率，并提出MRI/US融合TPB在未来的潜在应用。对现有文献进行了全面综述，包括系统评价、荟萃分析和临床指南，以比较经会阴和经直肠途径在前列腺癌检测中的效能和安全性。特别强调了mp-MRI引导的靶向活检及其与系统采样的结合。与经直肠途径相比，经会阴途径进行前列腺活检的检出率更高，尤其是对于前部病变，且感染风险降低，而并发症发生率（血尿、血精等）相似。由于经会阴途径感染率较低，强烈建议采用经会阴途径进行前列腺活检。最后，经会阴融合MRI/US活检对于初次活检阴性的患者进行重复活检或对接受主动监测的患者进行随访可能具有重要价值。MRI/US融合引导的TPB代表了前列腺癌诊断的重大进展，它将更高的精度与更低的感染风险相结合。虽然TPB对前列腺前部病变的检出率更高，活检后感染率更低，但与经直肠活检（TRB）相比，癌症检出率没有显著差异。有针对性的培训和投资可能通过减少住院、抗生素使用及相关成本来降低TPB的长期费用。未来的研究应进一步完善这种方法，并探索其与人工智能等新兴技术的整合，以提高病变靶向性和诊断准确性。
