Comparative Analysis of Transperineal Versus Transrectal Approaches for MRI-Targeted Biopsy of the Prostate for the Detection and Characterization of Prostate Cancer

Prostate cancer is the most common malignancy and the second most common cause of cancer
death in men in the Western hemisphere. Definitive diagnosis of prostate cancer relies on
biopsy of the prostate gland, which is historically performed by taking 12 random biopsies of
the prostate by placing a needle through the rectum under ultrasound guidance. Recently,
advances in MRI techniques have allowed identification of suspicious lesions within the
prostate prior to biopsy, which has given rise to targeting biopsy cores to high-suspicion
areas using fused ultrasound-MRI images. However, the most commonly used transrectal approach
to biopsy is associated with a growing rate of infectious complications as well as poor
sampling of the anterior region of the prostate, which is furthest from the rectum.

Inclusion Criteria:

- No contraindication to prostate biopsy (e.g. coagulopathy, medical condition
prohibiting abstinence from anti-platelet or anticoagulation therapies, anatomical
considerations) Area of suspicion or known cancer focus on previously obtained mpMRI
of the prostate (at least one lesion with MRI suspicion score >3/5)

Exclusion Criteria:

- Prior pelvic radiotherapy

- Evidence of urinary tract infection or significant urinary retention

- Prostate instrumentation (e.g. prostate biopsy, transurethral prostate procedure)
within 2 months prior to mpMRI

- No evidence of suspicious lesions on mpMRI

- Irreversible coagulopathy

- Contraindication to sedation