Local anesthetic transperineal (LATP) biopsy for prostate cancer detection is gaining in popularity due to concerns about infectious complications with transrectal ultrasound (TRUS) biopsy.
LATP detected a higher rate of clinically significant prostate cancers compared with TRUS in this randomized study from the U.K.
However, LATP took longer and more men found it painful and embarrassing.
Biopsy with local anesthetic ultrasound-guided transperineal (LATP) identified more clinically significant prostate cancers than transrectal ultrasound (TRUS), but the procedure came with tradeoffs, a multicenter randomized trial from the U.K. showed.
For the primary endpoint, LATP detected more Gleason Grade Group (GGG) 2 or higher tumors compared with TRUS among a group of biopsy-naive patients with a clinical suspicion of prostate cancer (60% vs 54%; OR 1.32, 95% CI 1.03-1.70, P=0.031), reported Richard Bryant, PhD, of the University of Oxford in England, and colleagues.
And while LATP also resulted in significantly fewer procedure-related symptoms beyond 7 days (18% vs 25%, respectively), it was accompanied by higher post-procedure pain and embarrassment (38% vs 27%) and took longer to perform (median 28 vs 22 minutes), the research team detailed in Lancet Oncology.
"To our knowledge, this is the first trial to show the superiority of LATP versus TRUS in detection of GGG 2 or higher prostate cancer," the study authors wrote. "The TRANSLATE trial provides randomized controlled trial [RCT] evidence regarding which type of prostate biopsy to perform in the outpatient setting in the diagnostic evaluation of men with possible prostate cancer. These findings will help to inform patients, clinicians, clinical guidelines, and policymakers regarding the important tradeoffs between LATP and TRUS prostate biopsy."
Results from the trial were simultaneously presented at the European Association of Urology Congress in Madrid.
Bryant and colleagues explained that LATP biopsy is gaining popularity due to concerns about infectious complications from TRUS biopsy, as well as "the perceived superiority of transperineal targeting of MRI-visible anterior and apical lesions." But until recently, the shift to LATP was based solely on evidence from cohort studies.
In the current study, infection rates were not significantly different between groups, but tended to be numerically lower with LATP biopsy.
While warning against cross-trial comparisons, Badar Mian, MD, of Albany Med Health System in New York, and colleagues noted that three previous RCTs of biopsy-naive men have reported similar rates of GGG 2 or higher tumors with LATP versus TRUS, with differences that were not significantly different:
"High-quality evidence from multiple RCTs conducted across diverse healthcare systems has shown no large difference in outcomes between LATP and TRUS," Mian and colleagues wrote in a commentary accompanying the study.
"This finding is ultimately reassuring for both patients and clinicians," they continued. "Based on the cumulative evidence from four RCTs (encompassing a total of nearly 3,000 participants), patients and practitioners can be confident that both TRUS and LATP procedures can be performed accurately and safely, with the choice guided by local circumstances."
TRANSLATE was a pragmatic, open-label superiority RCT that included 1,126 participants (median 66 years). The vast majority (92.7%) were white British, 71% had overweight or obesity, 78.6% had two or more comorbidities, 23.4% had a first-degree family history of prostate cancer, and 2.4% were taking finasteride.
A total of 1,087 were included in the study's primary analysis.
Infection requiring hospital admission in the first 7 days after biopsy occurred in 1% of men in both groups, while in the 4-month post-biopsy period there were numerically fewer infectious complications overall with LATP (1%) than with TRUS (2%).
Serious adverse events occurred in 2% and 4%, respectively.
No significant differences were observed in overall biopsy-related complications, urinary retention requiring catheterization, urinary symptoms, nor sexual function at 4 months after biopsy.
Bryant and colleagues noted that while statistically significant, the 6% difference between the LATP and TRUS groups for the primary endpoint was lower than the 10% hypothesized for the sample size calculation. They suggested this was mainly due to an almost 10% increase in the observed versus expected TRUS biopsy detection rate.
"Nonetheless, the difference still reached statistical significance with LATP detection rates of over 60%," they added. "We believe there are several reasons for this difference, including the improved targeting of radiological lesions via LATP, and improved detection of GGG 2 or higher prostate cancer with LATP in patients with anterior lesions on pre-biopsy MRI."
author['full_name']
Mike Bassett is a staff writer focusing on oncology and hematology. He is based in Massachusetts.
Disclosures
The study was funded by the U.K.'s National Institute for Health and Care Research.
Bryant reported relationships with BXTAccelyon, Cancer Research U.K., Prostate Cancer U.K., the National Institute for Health Research, and Koc University, is a member of the STAMINA trial's steering committee, and is an unpaid trustee of UCARE. Co-authors reported multiple relationships with industry.
The editorialists had no disclosures.
Primary Source
The Lancet Oncology
Source Reference: Bryant RJ, et al "Local anaesthetic transperineal biopsy versus transrectal prostate biopsy in prostate cancer detection (TRANSLATE): a multicentre, randomised, controlled trial" Lancet Oncol 2025; DOI: 10.1016/S1470-2045(25)00100-7.
Secondary Source
The Lancet Oncology
Source Reference: Mian BM, et al "Transrectal versus transperineal prostate biopsy: weighing the trade-offs" Lancet Oncol 2025; DOI: 10.1016/S1470-2045(25)00160-3.