Supplementary file 1_Comparative analysis of ultrasound-guided magnetic resonance imaging-cognitive fusion transrectal versus transperineal prostate biopsy: a 10-year single-center retrospective analysis.docx

ObjectivesProstate cancer (PCa) remains a leading malignancy among men worldwide. The diagnostic approach, particularly the biopsy route and integration with imaging, is crucial for accuracy. This study aimed to directly compare the diagnostic efficacy and safety of two ultrasound-guided, MRI-cognitively fused prostate biopsy approaches using a consistent extended 12 + X-core sampling scheme: the transperineal (TPB) versus the transrectal (TRB) route.
MethodsWe conducted a comparative, retrospective analysis of 3,208 patients who underwent prostate biopsy at our institution between January 2015 and January 2024. Patients were categorized into two cohorts: a historical TRB cohort (n = 1,078) from 2015–2018 and a subsequent TPB cohort (n = 2,130) from 2018–2024. Crucially, both cohorts were investigated using an identical 12 + X-core protocol under MRI-cognitive fusion guidance. Pathological outcomes, PCa detection rates, and perioperative complications were systematically compared. Multivariable logistic regression was employed to identify predictors of PCa detection.
ResultsThe TPB cohort demonstrated a significantly higher overall PCa detection rate (55.73% [1,187/2,130]) compared to the TRB cohort [50.46% (544/1,078); *p < 0.05]. Furthermore, TPB was associated with a superior safety profile, with minor complications (e.g., hematuria, low-grade fever, transient urinary symptoms) occurring in only 5.82% (124/2,130) of cases. Multivariable analysis confirmed established clinical predictors for PCa. Stratification of the detected cancers revealed that 1,701 patients (63.85%) were diagnosed with high-risk disease (Gleason score ≥8), outlining the distribution within our PCa population.
ConclusionIn this comparative study, the ultrasound-guided TPB with MRI-cognitive fusion and a 12 + X-core protocol demonstrated superior diagnostic efficacy and a more favorable safety profile compared to the TRB. These findings support the adoption of the TPB approach as a preferred clinical strategy for prostate biopsy.