Impact of a new diagnostic pathway for prostate cancer - From systematic transrectal to targeted MRI fusion transperineal biopsies

Purpose Advancements in prostate cancer diagnostics have changed the diagnostic pathway from traditional ultrasound-guided systematic transrectal biopsies to pre-biopsy prostate multiparametric MRI and targeted transperineal biopsies. This study aims to determine changes in prostate cancer detection rates, clinical outcomes, and treatment before (2018) and after (2023) implementing the new diagnostic pathway. Methods This retrospective study comprises two cohorts from two Danish hospitals - one from 2018 (n = 266) and one from 2023 (n = 304). In each cohort, men with suspected prostate cancer who underwent biopsies were analysed. Data were obtained from medical records. Categorical variables were compared using Chi-square or Fisher's exact test. Continuous variables were analysed with the Mann-Whitney U test in STATA version 18. P-value ≤ 0.05 was considered significant. Results The 2023 cohort showed a significantly higher detection of clinically significant prostate cancer (Gleason ≥ 3 + 4) compared to the 2018 cohort (65.41% vs. 41%, p < 0.01). Median Gleason scores increased from 6 to 7 (IQR 6–7 vs. 6–8, p < 0.01). Hospital admissions decreased from 11.3–3% (p < 0.01) in the 2023 cohort. Treatment and D’Amico’s risk groups showed no significant changes. Limitations include potential selection bias from only including biopsied patients, and findings limited to two Danish hospitals, reducing generalizability. Conclusion Transitioning to targeted transperineal biopsies improved cancer detection and reduced complications. While Gleason score increased, risk groups and treatment plans remained unchanged. These results support implementation in clinical practice, though further studies are needed to assess long-term outcomes and broader applicability.