In a U.K. trial (TRANSLATE) reported in The Lancet Oncology, Bryant et al found that local anesthetic transperineal (LATP) prostate biopsy detected more Gleason Grade Group (GGG) ≥ 2 prostate cancer compared with transrectal ultrasound (TRUS)-guided biopsy in previously biopsy-naive individuals who were suspected of having prostate cancer.
Study Details
In the multicenter open-label trial, 1,126 eligible individuals were randomly assigned between December 2021 and September 2023 to undergo TRUS (n = 564) or LATP (n = 562) biopsy.
The primary outcome measure of the study was detection of GGG ≥ 2 prostate cancer in the modified intention-to-treat (ITT) population.
Key Findings
In the modified ITT population, GGG ≥ 2 prostate cancer was identified in 329 (60%) of 547 participants with biopsy results in the LATP group vs 294 (54%) of 540 participants with biopsy results in the TRUS group (odds ratio [OR] = 1.32, 95% confidence interval [CI] = 1.03–1.70, P = .031).
Infection requiring admission to the hospital within 35 days after biopsy was observed in 2 (< 1%) of 562 participants in the LATP group vs 9 (2%) of 564 in the TRUS group. No significant differences between the LATP group and the TRUS group were observed in: overall biopsy-related complications (81% vs 77%, OR = 1.23, 95% CI = 0.93–1.65), urinary retention requiring catheterization (6% vs 5%), urinary symptoms (median International Prostate Symptom Score = 8 vs 8, OR = 0.36, 95% CI = –0.38 to 1.10), or sexual function (median International Index of Erectile Function score = 5 vs 8, OR = –0.60, 95% CI = –1.79 to 0.58) at 4 months after biopsy. Biopsy was considered immediately painful and embarrassing by 38% vs 27% participants (OR = 1.84, 95% CI = 1.40–2.43). Serious adverse events occurred in 2% vs 4% of participants.
The investigators concluded: “Among biopsy-naive individuals being investigated for possible prostate cancer, biopsy with LATP led to greater detection of GGG 2 or higher disease compared with TRUS. These findings will help to inform patients, clinicians, clinical guidelines, and policy makers regarding the important trade-offs between LATP and TRUS prostate biopsy.”
Richard J. Bryant, PhD, of the University of Oxford, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was supported by the National Institute for Health and Care Research (NIHR) Health Technology Assessment. For full disclosures of the study authors, visit thelancet.com.
