Local anaesthetic transperineal biopsy reduces infection and sepsis while improving cancer detection compared to transrectal ultrasonography methods

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BJU international Published June 1, 2026 Medically reviewed June 1, 2026 Study authors: Calpin Gavin G, Hehir Cian M, Alzayer Mariyah, MacCurtain Benjamin M, Ryan Fintan R, Inder Mohammud … PubMed ↗ DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Transperineal biopsy offers superior safety and detection compared to transrectal methods in prostate cancer screening.

This systematic review and meta-analysis evaluated 8,497 patients undergoing prostate biopsy to compare safety and efficacy between local anaesthetic transperineal and standard transrectal ultrasonography techniques. The study focused on critical outcomes including infection, sepsis, urinary retention, and cancer detection capabilities across different Gleason grade groups.

Results demonstrated that the transperineal approach significantly reduced infection rates with a risk ratio of 0.68 and sepsis rates with a risk ratio of 0.16. These reductions were statistically significant with p-values less than 0.001 for both outcomes. Urinary retention rates remained comparable between the two methods, showing no significant difference in this adverse event.

Cancer detection performance favored the transperineal technique, which showed significantly higher overall detection rates and better identification of clinically significant cancers. The risk ratio for overall detection was 1.07, while detection of Gleason Grade Group 2-5 cancers reached a risk ratio of 1.12. Detection of low-grade Gleason Grade 1 cancers remained comparable between groups.

Study Details

Study typeMeta analysis

Sample sizen = 8,497

EvidenceLevel 1

PublishedJun 2026

PMID41800666

View Original Abstract ↓

OBJECTIVE: To compare transrectal ultrasonography (TRUS) and local anaesthetic transperineal (LATP) biopsy. METHODS: A systematic review of randomised control trials and prospective studies meeting eligibility criteria was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: A total of 12 studies with 8497 patients were included. LATP biopsy was performed in 3961 patients and TRUS biopsy in 4536. Patient characteristics were comparable in both groups. Infection (risk ratio [RR] 0.68, 95% confidence interval [CI] 0.56-0.84, P < 0.001) and sepsis rates were significantly lower in the LATP group (RR 0.16, 95% CI 0.08-0.33, P < 0.001) and urinary retention rates were comparable (RR 0.87, 95% CI 0.61-1.25, P = 0.46). Overall cancer detection rates were significantly higher in LATP biopsy (RR 1.07, 95% CI 1.03-1.10, P < 0.001) as were Gleason Grade Group 2-5 or clinically significant cancer detection rates (RR 1.12, 95% CI 1.06-1.18, P < 0.001). Gleason GG 1 detection rates were comparable (RR 0.92, 95% CI 0.82-1.04, P = 0.20). CONCLUSION: The LATP biopsy is associated with lower rates of infection and sepsis compared to TRUS biopsy. The LATP biopsy also detects a higher overall incidence of prostate cancer and clinically significant prostate cancer (Gleason Grade Group 2-5).