Mac Curtain Benjamin M, Calpin Gavin, Bruinsma Josh, Qian Wanyang, Deshwal Avinash, Collins Eoin, Temperley Hugo C, Mac Curtain Reuben D, Shields William P, Yap Lee Chien, Cozman Claudiu, Keane John, Daly Padraig
Royal College of Surgeons in Ireland Dublin Ireland.
Department of Urology University Hospital Waterford Waterford Ireland.
BJUI Compass. 2025 Apr 8;6(4):e70016. doi: 10.1002/bco2.70016. eCollection 2025 Apr.
Transperineal prostate biopsy (TPPB) under local anaesthesia is a widely employed biopsy method, and is currently endorsed by the European Association of Urology (EAU). This review aimed to assess the pooled detection rates of clinically significant prostate cancer using TPPB under local anaesthetic. Additionally, pain scores and complications were also reported.
Our search was conducted in line with the most recent Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations up to August 2024. The study was registered on PROSPERO under the ID: CRD42024588824. An electronic search was conducted of the PubMed, Embase and Cochrane Central Register of Controlled Trials databases along with grey literature using the Google search engine.
In total, there were 2881 patients included in this review. Biopsy histology results were reported in 11 studies comprising 2781 cases. We observed a clinically significant prostate cancer rate of 52% (95% CI 44%-60%) for studies that employed both a mix of systematic and targeted biopsies and 26% (95% CI 23%-30%) when systematic biopsies alone were taken. The pooled rate was 48% (95% CI 37%-59%), overall. Complications after prostate biopsies were reported by 9 studies with a combined 2688 patients. There were 61 patients (2.3%) who had Clavien-Dindo (CD) 1-2 complications and three patients (0.1%) who had CD 3-5 complications. The pooled rate of CD 1 and 2 complications was 2% (95% CI 1%-4%).
TPPB under local anaesthetic is a safe, efficacious and well-tolerated method of prostate biopsy when compared with other methods. Undertaking the procedure under local anaesthesia does not seem to lower cancer detection rates.
局部麻醉下经会阴前列腺穿刺活检（TPPB）是一种广泛应用的活检方法，目前得到欧洲泌尿外科学会（EAU）的认可。本综述旨在评估局部麻醉下使用TPPB对临床显著前列腺癌的汇总检出率。此外，还报告了疼痛评分和并发症情况。
我们按照截至2024年8月的最新系统评价和Meta分析的首选报告项目（PRISMA）建议进行检索。该研究已在国际前瞻性系统评价注册库（PROSPERO）上注册，注册号为：CRD42024588824。使用谷歌搜索引擎对PubMed、Embase和Cochrane对照试验中心注册库数据库以及灰色文献进行电子检索。
本综述共纳入2881例患者。11项研究报告了活检组织学结果，共2781例病例。我们观察到，采用系统活检和靶向活检相结合的研究中，临床显著前列腺癌的发生率为52%（95%可信区间44%-60%），仅采用系统活检时为26%（95%可信区间23%-30%）。总体汇总率为48%（95%可信区间37%-59%）。9项研究报告了前列腺穿刺活检后的并发症，涉及2688例患者。有61例患者（2.3%）发生Clavien-Dindo（CD）1-2级并发症，3例患者（0.1%）发生CD 3-5级并发症。CD 1和2级并发症的汇总发生率为2%（95%可信区间1%-4%）。
与其他方法相比，局部麻醉下的TPPB是一种安全、有效且耐受性良好的前列腺活检方法。在局部麻醉下进行该操作似乎不会降低癌症检出率。
