Multicenter randomized trial of local anesthetic transperineal biopsy versus transrectal biopsy in prostate cancer detection

The randomized TRANSLATE trial, at ten centers in the UK, compared local anesthetic transperineal biopsy (LATP) with transrectal prostate biopsy (TRUS) for detection of Gleason Grade Group (GGG) 2 or higher prostate cancer. The trial included prostate biopsy-naïve men with suspicion of prostate cancer, who were randomized 1:1 to TRUS (n=564) or LATP (n=562) biopsy. GGG2 or higher prostate cancer was detected in 60% of participants with biopsy results in the LATP group versus 54% of participants with biopsy results in the TRUS group (OR 1.32; p=0.031). Infection requiring hospitalization occurred in 2 participants in the LATP group compared with 9 participants in the TRUS group. No statistically significant difference was observed in biopsy-related complications. Trial participants more commonly reported LATP biopsy to be painful and embarrassing compared with TRUS (38% versus 27%; OR 1.84; 95% CI 1.40-2.43). Serious adverse events occurred in 2% of participants in the LATP group and 4% in the TRUS group. The authors conclude that among biopsy-naïve individuals being investigated for possible prostate cancer, biopsy with LATP led to greater detection of GGG2 or higher disease compared with TRUS.