Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: a systematic review and meta-analysis

Jianjian Xiang, Huaqing Yan, Jiangfeng Li, Xiao Wang, Hong Chen, Xiangyi Zheng, Jianjian Xiang, Huaqing Yan, Jiangfeng Li, Xiao Wang, Hong Chen, Xiangyi Zheng

Abstract

Background: Because conventional prostate biopsy has some limitations, optimal variations of prostate biopsy strategies have emerged to improve the diagnosis rate of prostate cancer. We conducted the systematic review to compare the diagnosis rate and complications of transperineal versus transrectal prostate biopsy. We searched for online publications published through June 27, 2018, in PubMed, Scopus, Web of Science, and Chinese National Knowledge Infrastructure databases. The relative risk and 95% confidence interval were utilized to appraise the diagnosis and complication rate. The condensed relative risk of 11 included studies indicated that transperineal prostate biopsy has the same diagnosis accuracy of transrectal prostate biopsy; however, a significantly lower risk of fever and rectal bleeding was reported for transperineal prostate biopsy. No clue of publication bias could be identified.

Short conclusion: To conclude, this review indicated that transperineal and transrectal prostate biopsy have the same diagnosis accuracy, but the transperineal approach has a lower risk of fever and rectal bleeding. More studies are warranted to confirm these findings and discover a more effective diagnosis method for prostate cancer.

Keywords: Complication; Diagnosis accuracy; Prostate biopsy; Transperineal; Transrectal.

Conflict of interest statement

Ethics approval and consent to participate

All analyses were based on previous published studies thus no ethical approval and patient consent are required.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of study assessment and selection
Fig. 2
Fig. 2
Relative risks for RCTs assessing the diagnosis rate of the TP approach vs the TR approach. Notes: diamonds represent study-specific relative risks (RRs) or summary relative risks with 95% confidence intervals (CIs). Horizontal lines represent 95% CIs. Test for heterogeneity among studies: P = 0.678, I2 = 0.0%
Fig. 3
Fig. 3
Relative risks for observational studies assessing the diagnosis rate of the TP approach vs the TR approach. Notes: diamonds represent study-specific relative risks (RRs) or summary relative risks with 95% confidence intervals (CIs). Horizontal lines represent 95% CIs. Test for heterogeneity among studies: P = 0.151, I2 = 36.3%
Fig. 4
Fig. 4
Egger’s publication bias plot for RCTs. Notes: Egger’s regression asymmetry test (P = 0.74). Standardized effect was defined as the odds ratio divided by its standard error. Precision was defined as the inverse of the standard error
Fig. 5
Fig. 5
Egger’s publication bias plot for observational studies. Notes: Egger’s regression asymmetry test (P = 0.49). Standardized effect was defined as the odds ratio divided by its standard error. Precision was defined as the inverse of the standard error

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