Transperineal biopsy is associated with higher rates of Gleason grade group upgrading in prostate adenocarcinoma when compared with transrectal ultrasound biopsy

Purpose : Histopathological assessment of prostate biopsies (PBx) remains the mainstay of diagnosis in prostate cancer (PCa). The Gleason grade group score (GGG) is a critical parameter used for diagnosis, risk stratification and management in PCa. In our institution transperineal (TP) PBx has become the favoured biopsy method, largely due to its increased accuracy and lower risk of infection. Our review analysed the GGG concordance rates between PBx and radical prostatectomy (RP) specimens with a focus on biopsy method. Method : A total of 588 patients who underwent RP between January 2016 and December 2022 were included in our analysis. Clinicopathological data was collected from the laboratory information system. A chi-square and Mann-Whitney U test were used for categorical and continuous variables, respectively. Results : TRUS biopsy was performed in 79% of cases, while TP PBx was performed in 21%. Concordance between PBx and RP was observed in 58% of cases, with 22% being upgraded and 20% downgraded. Biopsy method, extra-prostatic extension and positive surgical margin status were all found to be significantly associated with GGG upgrading. Conclusion : TP biopsies is the favoured biopsy method in our institution and review reveals higher rates of GGG upgrading is associated with this approach. This presents a dilemma as TP PBx may compromise the precision of cancer grading in favour of reduced side effects. Ongoing monitoring of PBx and their outcomes is essential for optimal balance between diagnostic accuracy and procedure side effects.