For many years, transrectal ultrasound‐guided (TRUS) prostate biopsies have been performed to establish a histological diagnosis of prostate cancer. This has been the recommended standard of care procedure, but has always carried risks, in particular the risk of post‐procedural sepsis, and the associated antibiotic burden and risk of development of antibiotic resistance. Transperineal (TP) prostate biopsies performed under local anaesthetic (LA) have been proposed as a possible solution to these issues, with potentially lower infectious complications, and avoidance of need for antibiotic prophylaxis. The European Association of Urology produced guidance in 2023 with ‘weak’ recommendations in favour of LATP biopsy as a new standard of care, citing its safety profile. Both the National Institute for Health and Care Excellence in the UK, and the American Urological Association in the United States, have concluded for now that the body of evidence is inadequate and not offered a similar recommendation. We discuss the available evidence, pros and cons of each technique, and the status of current trials in the field. We believe that clinical equipoise remains necessary, given the disparity in national and international guidelines highlighting the need for large randomised controlled trials to answer the question: is LATP biopsy really better than TRUS biopsy?

中文翻译：

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技术展望——前列腺癌：局麻经会阴前列腺活检真的比经直肠活检更好吗？

多年来，人们一直通过经直肠超声引导（TRUS）前列腺活检来建立前列腺癌的组织学诊断。这是推荐的护理程序标准，但始终存在风险，特别是术后败血症的风险，以及相关的抗生素负担和产生抗生素耐药性的风险。局部麻醉 (LA) 下进行的经会阴 (TP) 前列腺活检已被提议作为这些问题的可能解决方案，可能会降低感染并发症，并避免需要抗生素预防。欧洲泌尿外科协会于 2023 年发布了指南，其中“弱”建议支持 LATP 活检作为新的护理标准，并指出其安全性。英国国家健康与护理卓越研究所和美国泌尿外科协会目前都得出结论，证据不足，没有提出类似的建议。我们讨论了现有的证据、每种技术的优缺点以及当前该领域试验的状态。我们认为，鉴于国家和国际指南的差异强调需要大型随机对照试验来回答以下问题，临床平衡仍然是必要的：LATP 活检真的比 TRUS 活检更好吗？