与经直肠 (TR) 方法相比，磁共振成像 (MRI) 靶向经会阴 (TP) 前列腺活检 (TP-Tbx) 检测具有临床意义的前列腺癌 (csPCa) 的优势和安全性仍然存在争议。本综述旨在比较 TP-Tbx 和 MRI 靶向 TR 活检 (TR-Tbx) 的有效性和安全性。在 PubMed/Medline、Scopus 和 Web of Science 中进行了系统文献检索，以确定前瞻性随机对照试验的记录(RCT) 比较了截至 2024 年 5 月发表的 TP-Tbx 和 TR-Tbx。主要结局包括 csPCa（国际泌尿病理学会 [ISUP] ≥2）的检出率和并发症发生率。三项 RCT（PREVENT、ProBE-PC、和完美）符合纳入标准。 TR 技术通常与抗生素预防一起使用，以减轻感染风险或在直肠拭子之后使用。 TP-Tbx 和 TR-Tbx 在 csPCa（比值比 [OR] 0.9，95% 置信区间 [CI]：0.7-1.1）或 ISUP 1 前列腺癌（PCa；OR 1.1，95%）方面没有发现差异CI：0.8-1.4）检测。术后感染（OR 0.8，95% CI：0.4-1.8）、败血症（OR 0.6，95% CI：0.1-4.5）和尿潴留率（OR 0.5，95% CI：0.1-1.6）相似。 TP 入路期间的疼痛略高于 TR 入路期间的疼痛，但随访 7 天后，两种入路之间的差异很小。每个患者的活检数量、患者选择、5-α还原酶抑制剂的使用、针头尺寸、TP技术和疼痛评分（仅在一项随机对照试验中报告）的差异，以及随机对照试验的多中心性质，限制了该研究。 TP-Tbx和 TR-Tbx 在检测 PCa 方面显示出相似的结果，在感染率、尿潴留率和管理活检相关疼痛方面的有效性也相当。与 TR-Tbx 不同，TP-Tbx 可以安全地省略抗生素，而不会增加感染风险。由于感染问题而排除使用预防性抗生素进行 TR-Tbx 实践的趋势可能会有所缓和；然而，尽管缺乏统计学意义，一些关键结果（如感染和脓毒症）的方向性有利于 TP 方法。前列腺癌检测的前列腺活检方法（经会阴 [TP] 与经直肠 [TR]）没有显着差异和并发症。然而，MRI 靶向 TP 前列腺活检方法可能是有利的，因为它可以在不使用抗生素的情况下安全地进行，从而可能减少抗生素耐药性。版权所有 © 2024 作者。由 Elsevier B.V. 出版。保留所有权利。

The benefits of the detection of clinically significant prostate cancer (csPCa) and safety of magnetic resonance imaging (MRI)-targeted transperineal (TP) prostate biopsy (TP-Tbx) versus transrectal (TR) approaches are still a matter of debate. This review aims to compare the efficacy and safety of TP-Tbx and MRI-targeted TR biopsy (TR-Tbx).A systematic literature search was performed in PubMed/Medline, Scopus, and Web of Science to identify records of prospective randomized controlled trials (RCTs) comparing TP-Tbx and TR-Tbx published until May 2024. The primary outcomes included detection rates of csPCa (International Society of Urological Pathology [ISUP] ≥2) and rates of complications.Three RCTs (PREVENT, ProBE-PC, and PERFECT) met the inclusion criteria. The TR technique was commonly administered with antibiotic prophylaxis to mitigate infection risks or after a rectal swab. No difference was found between TP-Tbx and TR-Tbx in terms of either csPCa (odds ratio [OR] 0.9, 95% confidence interval [CI]: 0.7-1.1) or ISUP 1 prostate cancer (PCa; OR 1.1, 95% CI: 0.8-1.4) detection. Postprocedural infection (OR 0.8, 95% CI: 0.4-1.8), sepsis (OR 0.6, 95% CI: 0.1-4.5), and urinary retention rates (OR 0.5, 95% CI: 0.1-1.6) were similar. Pain during the TP approach was slightly higher than during the TR approach, but after 7 d of follow-up, the differences between the two approaches were minimal. Variations in biopsy numbers per patient, patient selection, use of 5-alpha reductase inhibitors, needle sizes, TP techniques, and pain scores (reported in only one RCT), along with the multicenter nature of RCTs, limit the study.TP-Tbx and TR-Tbx show similar results in detecting PCa, with comparable rates of infections, urinary retention, and effectiveness in managing biopsy-associated pain. TP-Tbx can safely omit antibiotics without increasing infection risk, unlike TR-Tbx. The tendency to exclude from practice TR-Tbx with prophylactic antibiotics due to infection concerns could be moderated; however, the directionality of some key outcomes, as infections and sepsis, favor the TP approach despite a lack of statistical significance.There were no significant differences in the prostate biopsy approaches (transperineal [TP] vs transrectal [TR]) for prostate cancer detection and complications. However, the MRI-targeted TP prostate biopsy approach may be advantageous as it can be performed safely without antibiotics, potentially reducing antibiotic resistance.Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.