The Great Prostate Biopsy Debate: Transperineal vs. Transrectal
– What the Evidence Really Shows Prostate Biopsy Methods: Why America Lags Behind on Safety and Accuracy While Economic Interests Override Evidence TL;DR: Transperineal (TP) prostate biopsies are safer and more accurate than transrectal (TR) biopsies, detecting 6% more cancers while virtually eliminating life-threatening infections. Europe and Australia switched to TP as the standard in 2021, citing infection prevention and antimicrobial stewardship. Yet U.S. guidelines still call both methods "equivalent" despite mounting evidence. The resistance to change stems from powerful economic and workflow incentives: TR biopsies are faster, more profitable for office-based practices, and don't require costly equipment upgrades. Meanwhile, claims that TR is "more cost-effective" ignore massive downstream costs including antibiotic resistance and sepsis treatment. For Active Surveillance patients requiring repeated biopsies over years, the choice between methods could ...