Prostate biopsy remains a cornerstone in the diagnostic pathway for elevated PSA and/or suspicious lesions on multiparametric MRI. While transrectal ultrasound-guided biopsy (TRUS) has long been the standard approach, the transperineal (TP) technique is increasingly favoured for its superior safety profile, enhanced diagnostic yield—particularly for anterior and apical tumours—and near-zero infection rates.
This presentation aims to:
- Outline the TP biopsy technique using the PrecisionPoint™ device under local anaesthesia (LA),
- Review the evidence driving the transition from TRUS to TP, including data from landmark studies such as TRANSLATE [1], PREVENT [2], and PERFECT [3],
- Share real-world experience and outcomes from a high-volume UK centre.

1. A literature review on the clinical advantages of TP biopsy over TRUS, focusing on key benchmark publications.
2. Presentation of our institutional TP biopsy protocol and technique.
3. A retrospective analysis of the most recent 200 TP biopsies performed at our centre, assessing complication rates and cancer detection outcomes.

Over 2,000 TP biopsies under LA have been performed at our centre, averaging 20 per week. In our recent cohort of 200 patients:
- Mean age: 64.7 years (range 27–82)
- Pre-biopsy imaging: 94% had MRI; the remainder had CT scans
- PIRADS distribution:
  - PIRADS 4: 34.5%
  - PIRADS 5: 27%
  - PIRADS 3: 21%
  - PIRADS 2: 5%
  - Unspecified PIRADS: remainder
- Cancer detection rate: 74% (148/200 patients)
- Infectious complications: 1 patient developed a urinary tract infection (confirmed by MSU) and required admission for intravenous antibiotics.
- No other biopsy-related complications or hospital admissions were recorded.

Our data confirms that TP biopsy under LA is safe, well tolerated, and diagnostically effective. The infection rate is extremely low, and the cancer detection rate is high. While a small number of patients reported discomfort or embarrassment, most preferred the TP approach under LA over general anaesthesia. Our institutional prostate cancer pathway, which includes strict criteria for offering biopsy, likely contributes to the high detection rate by improving patient selection and minimising unnecessary procedures.
Figure 1 illustrates our local diagnostic and treatment pathway.

Although TP biopsy has a steeper learning curve compared to TRUS, we strongly advocate for its global adoption. The long-term benefits—including improved diagnostic accuracy, enhanced patient safety, and reduced antibiotic resistance—clearly outweigh the challenges of initial implementation and training.

Local anaesthetic transperineal biopsy versus transrectal prostate biopsy in prostate cancer detection (TRANSLATE): a multicentre, randomised, controlled trial. Bryant R, et al. The Lancet Oncology Volume 26, Issue 5, P583-595, May 2025
Transperioneal versus transrectal magnetic resonance imaging – targeted and systematic prostate biopsy to prevent infectious complications: The PREVENT randomized trial. Hu J, et al. Eur Urol. 2024 Jul;86:61-68
Transperineal verusus transrectal magnetic resonance imaging – targeted biopsies for prostate cancer diagnosis: final results of the randomized PERFECT trial (CCAFU-PR1). Ploussard et al. Eur Urol Oncol.2024 Oct;7(5):1080-1087