Implementing Transperineal Prostate Biopsy in High-Volume Hospitals and Academic Settings
In large hospital and academic environments, prostate biopsy protocols are increasingly evaluated based on infection risk, diagnostic accuracy, and workflow efficiency. As imaging techniques have advanced – and concerns for patient safety have increased– the transperineal (TP) prostate approach to prostate biopsy has been shown to offer potential benefits in comparison to the traditional transrectal (TR) method, particularly with regards to infection rates, as institutions aim to reduce post-procedure complications and antibiotic utilization.1 Research indicates that TP biopsies can not only offer a lower risk of infection, but also offer better access to portions of the prostate that are considered challenging, as well as compatible with MRI-targeted biopsy techniques.12 3
This need to reduce infection risk is particularly relevant in high-volume centers, with many published studies reporting strong outcomes for transperineal biopsy coming from large hospitals, academic institutions, and tertiary care centers. Although it’s arguable how feasible it would be to perform TP biopsy exclusively in small hospitals or private practices, there are indications that large hospitals and academic institutions are well-suited to provide beneficial environments for TP biopsy.
The key factors that make large hospitals and academic institutions well-suited for TP biopsy include procedural experience, advanced imaging capabilities, multidisciplinary collaboration, and infrastructure.
How Can Procedural Experience Improve Transperineal Biopsy Outcomes?
When it comes to TP biopsies, there is often a learning curve.
Recent medical research shows a link between experience and improved detection rates. In one single-center study by Hiseh et al. (2023), clinically significant prostate cancer detection by MRI/US fusion targeted biopsy increased over time (35% to 60%) as the team gained experience. 4
Larger hospitals and academic institutions possess several inherit benefits when it comes to helping with this initial learning curve. These include:
Increased numbers of patients allow for more rapid progression through the learning curve
The ability to standardize the technique across more providers
Sampling and targeting of suspicious lesions can be optimized based on previous experiences of multiple clinicians
Lower-volume institutions can achieve similar advantages, but might take longer to realize the benefits.
In high-volume settings, this accelerated learning curve enables faster optimization of technique and potentially more consistent detection of clinically significant disease.
How Does Advanced Imaging Improve Targeting in Transperineal Prostate Biopsy?
Transperineal prostate biopsies are ideally suited for sampling of the anterior regions of the prostate that can be challenging to sample using the TR approach. 5 Hansen et al. (2018) documented that MRI-supported TP biopsy provided excellent detection rates for clinically significant disease. 6
Hospitals and academic institutions that are bigger in size tend to have:
More specialized prostate MRI programs
Higher number of radiologists with expertise in prostate imaging
Greater availability of fusion biopsy platforms
How Does Multidisciplinary Collaboration Between Disciplines Facilitate More Accurate Results?
Another characteristic of large institutions that is often overlooked is the organization of the delivery of care. TP biopsy does not occur in isolation, but rather, occurs at the interface between urologists, radiologists, pathologists and interventional support teams. This type of collaboration can enhance the entire biopsy process.
Research supports the value of multidisciplinary collaboration. Scarcia et al. (2025) noted that in addition to collaborative processes, and standardization of workflow, regular team meetings contributed to improved detection rates. 7 This type of coordinated approach enables alignment between imaging interpretation, biopsy execution, and pathology review.
In large hospital and academic environments, multidisciplinary collaboration is common. Tumor boards, combined case reviews, and interdisciplinary care pathways facilitate alignment of the disciplines involved.
How Do High-Volume Institutions Generate Data to Advance the Field?
Another important consideration is the generation of data to advance the field, with significant data having been generated with regards to TP biopsies via larger institutions.
Examples of this include Sandberg et al. (2024) who analyzed 767 TP biopsies performed at a single academic center as part of their study. 8 In another single-center study, Immerzeel et a. (2022) examined over 1000 procedures that had been performed under local anesthesia. 9
Obtaining this significant amount of information is much more feasible to accomplish in high-volume environments, where data is continually being generated, analyzed and implemented.
These large datasets play a critical role in refining technique, validating outcomes, and informing practices for broader clinical adoption.
What Is the Importance of a Standardized Workflow?
Many instances of TP biopsy can be completed under local anesthesia, without antibiotics, and in an outpatient setting. 10 However, designing a workflow that meets these criteria requires careful planning and execution.
Studies demonstrating that it is possible to maintain low rates of infection while avoiding the use of antibiotic prophylaxis include Westerhout et al. (2026). This study included data from almost 2000 procedures at high-volume centers.11 Berkenwald et al. (2021) demonstrated that as teams became more experienced, the duration of the procedures decreased. 12
Standardization is especially important in academic and high-volume settings, where multiple providers perform the procedure. In these environments, efficiency is not only a clinical goal but also an operational priority, particularly as procedure volumes increase.
As workflows become more standardized, tools and technologies that support procedural efficiency, consistency, and ease of adoption will play an increasingly important role.
Key Takeaways
Published evidence supports transperineal prostate biopsy as an increasingly used approach associated with low infectious complication rates and compatibility with MRI-targeted workflows in appropriate clinical settings. High-volume hospitals and academic centers may be well positioned to implement transperineal biopsy programs because of available imaging resources, multidisciplinary teams, training infrastructure, and standardized workflows. Broader adoption should account for institutional resources, clinician experience, patient selection, and local clinical protocols.
References:
#1: Marra G, Bazzurro F, Dematteis A, et al. Transperineal Versus Transrectal Biopsy for Prostate Cancer Diagnosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. European urology oncology. Published online 2026. doi:10.1016/j.euo.2026.01.009
#2: Drăgoescu PO, Drocaș AI, Drăgoescu AN, et al. Transperineal Prostate Biopsy Targeted by Magnetic Resonance Imaging Cognitive Fusion. Diagnostics (Basel, Switzerland). 2023;13(8). doi:10.3390/diagnostics13081373
#3: Grummet J, Pepdjonovic L, Huang S, Anderson E, Hadaschik B. Transperineal vs. transrectal biopsy in MRI targeting. Translational andrology and urology. 2017;6(3):368-375. doi:10.21037/tau.2017.03.58
#4: Hsieh P-F, Li P-I, Lin W-C, et al. Learning Curve of Transperineal MRI/US Fusion Prostate Biopsy: 4-Year Experience. Life (Basel, Switzerland). 2023;13(3). doi:10.3390/life13030638
#5: Paesano N, Picola N, Muñoz-Rodriguez J, et al. Efficacy of Prostate Biopsies via Transperineal and Transrectal Routes for Significant Prostate Cancer Detection: A Multicenter Paired-Matched Study. Diagnostics (Basel, Switzerland). 2025;15(3). doi:10.3390/diagnostics15030288
#6: Hansen N, Patruno G, Wadhwa K, et al. Magnetic Resonance and Ultrasound Image Fusion Supported Transperineal Prostate Biopsy Using the Ginsburg Protocol: Technique, Learning Points, and Biopsy Results. European Urology. 2016;70(2):332-340. doi:10.1016/j.eururo.2016.02.064
#7: Scarcia M, Andracchio V, Piana A, et al. Learning curve of a multidisciplinary team for magnetic resonance imaging/transperineal ultrasonography fusion prostate biopsy. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2025;97(3):13933. doi:10.4081/aiua.2025.13933
#8: Sandberg M, Whitman W, Greenberg J, et al. Risk factors for infection and acute urinary retention following transperineal prostate biopsy. International urology and nephrology. 2024;56(3):819-826. doi:10.1007/s11255-023-03854-0
#9: Immerzeel J, Israël B, Bomers J, et al. Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 4: Transperineal Magnetic Resonance-Ultrasound Fusion Guided Biopsy Using Local Anesthesia. European Urology. 2022;81(1):110-117. doi:10.1016/j.eururo.2021.10.032
#10: Sebastian Lenart, Osama Shahin, Malavika Krishnakumar, et al. Accuracy and safety of in-office transperineal freehand cognitive fusion prostate biopsy under local anaesthesia without antibiotic prophylaxis. Scientific Reports. 2025;15(1):1-8. doi:10.1038/s41598-025-23101-z
#11: Westerhout SF, Rynja SP, van Steenbergen JPZ, et al. Antibiotic Prophylaxis Is Not Required Before MRI-Guided Transperineal Prostate Biopsy. Urology. 2026;207:166-171. doi:10.1016/j.urology.2025.08.006
#12: Berkenwald A, Stensland KD, Sebel LE, Moinzadeh A, Faust W. Initial transperineal prostate biopsy experience at a high-volume center. The Canadian journal of urology. 2021;28(3):10692-10698.
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