Local anesthetic transperineal (LATP) biopsy is increasingly favored for prostate cancer detection due to lower infectious risks compared to transrectal ultrasound (TRUS) biopsy. A U.K.-based randomized trial found that LATP detected a higher rate of clinically significant prostate cancers than TRUS. However, the procedure took longer, and more men reported experiencing pain and discomfort during LATP. While LATP demonstrated superior diagnostic accuracy, its drawbacks included increased procedural time and patient-reported discomfort. The study was conducted by Bryant RJ and colleagues published in The Lancet Oncology journal.LATP has been increasing in popularity with the concern of infectious complications related to TRUS biopsy and perceived advantages of transperineal targeting for MRI-visible anterior and apical prostate cancer lesions. Before this trial, the choice of LATP was mostly based on cohort studies instead of solid RCT data. The TRANSLATE trial sought to produce high-grade evidence comparing the two methods in an outpatient environment.Earlier RCTs, such as ProBE-PC, PREVENT, and PERFECT, had comparable LATP vs TRUS detection rates of GGG 2 or greater tumors, with the differences not being statistically significant:ProBE-PC: 62% vs 59%PREVENT: 53% vs 50%PERFECT: 47% vs 54%Experts advise against cross-trial comparison and point out that both biopsy techniques continue to be valid alternatives for the detection of clinically significant prostate cancer.TRANSLATE was an open-label, pragmatic superiority RCT recruiting 1,126 biopsy-naive men with suspected prostate cancer. The median age of participants was 66 years. Among the study population:92.7% were White British71% had overweight or obesity78.6% had two or more comorbidities23.4% had a first-degree family history of prostate cancer2.4% were on finasterideA total of 1,087 patients were enrolled in the primary analysis, comparing LATP and TRUS biopsy efficacy and safety.Key FindingsPrimary Endpoint: Detection of GGG 2 or greater prostate cancer was greater with LATP (60%) compared with TRUS (54%) (OR 1.32, 95% CI 1.03-1.70, P=0.031).Procedure-Related Symptoms: Fewer patients in the LATP arm experienced symptoms after more than 7 days (18% vs 25%).Post-Procedure Pain and Embarrassment: These side effects were more commonly experienced by patients in the LATP group (38% vs 27%).Procedure Time: LATP took a median time of 28 minutes versus 22 minutes for TRUS.Infection Rates: Infection necessitating hospital admission within 7 days happened in 1% of each group, but overall infection rates over 4 months were less with LATP (1% vs 2%).Serious Adverse Events: These were seen in 2% of LATP patients and 4% of TRUS patients.Other Biopsy-Related Complications: No differences were found in urinary retention necessitating catheterization, urinary symptoms, or sexual function at 4 months after biopsy.The TRANSLATE trial demonstrates robust RCT evidence of LATP superiority compared to TRUS for the detection of GGG 2 or greater prostate cancer. These results will assist in informing clinical practice guidelines, patient education, and future policy decisions about prostate cancer biopsy techniques.Reference:Bryant, R. J., Marian, I. R., Williams, R., Lopez, J. F., Mercader, C., Raslan, M., Berridge, C., Whitburn, J., Campbell, T., Tuck, S., Barber, V. S., Scaife, J., Hewitt, A., Taylor, A., Ooms, A., Landeiro, F., Little, M., Wolstenholme, J., Ghosh, S., … Unsworth, L. (2025). Local anaesthetic transperineal biopsy versus transrectal prostate biopsy in prostate cancer detection (TRANSLATE): a multicentre, randomised, controlled trial. The Lancet Oncology. https://doi.org/10.1016/s1470-2045(25)00100-7