Objective To analyze the incidence of complications in patients with transperineal targeted combination systematic biopsy for prostate.

Methods Clinical materials of patients with transperineal biopsy for prostate in the Department of Urinary Surgery of the Dongtai City People's Hospital from January 2019 to May 2022 were retrospectively analyzed. According to the Prostate Imaging Reporting and Data System (PI-RADS) score, the patients were divided into systematic biopsy group (PI-RADS score < 3) and targeted combination systematic biopsy group (PI-RADS score ≥3). General clinical materials and incidence conditions of post-biopsy complications such as infection, hematuria, perineal hematoma, urinary retention, lower urinary tract symptoms, and vagal nerve reflex were collected; the occurrence of prostate biopsy related complications were compared between the two groups.

Results A total of 432 patients were enrolled in this study, with 292 cases in the targeted combination systematic biopsy group and 140 cases in the systematic biopsy group. The age, prostate specific antigen (PSA), prostate specific antigen density (PSAD) and body mass index (BMI) in the targeted combination systematic biopsy group were significantly higher than those in the systematic biopsy group, while the prostate volume was significantly smaller than that in the systematic biopsy group (P < 0.05 or P < 0.01). The number of biopsy needles in the targeted combination systematic biopsy group was (15.6±1.1), which was significantly higher than (13.2±0.8) in the systematic biopsy group (P < 0.01). The overall positive rate of biopsy in 432 patients was 46.5% (201/432), and the incidence rate of clinically significant prostate cancer (csPCa) was 38.0% (164/432). The positive rate and incidence rate of csPCa in the targeted combination systematic biopsy group were 59.6% (174/292) and 52.4% (153/292) respectively, which were significantly higher than 19.3% (27/140) and 7.9% (11/140) in the systematic biopsy group (P < 0.01). In terms of complications such as hematuria and its severity, hemospermia, infection, urinary retention and vagal nerve reflex, the incidence rates of targeted combination systematic biopsy group were higher than those of systematic biopsy group, but there was no significant between-group difference (P>0.05). The total incidence of perineal hematoma in the targeted combination systematic biopsy group was 21.57%, which showed no significant difference when compared to 17.14% in the systematic biopsy group (P>0.05); however, the incidence rates of moderate and severe perineal hematoma in the targeted combination systematic biopsy group were significantly higher than those in the systematic biopsy group (P < 0.01). It was observed that the hematoma was absorbed after conservative treatment, and there was no operative complication with Clavien grading greater than grade Ⅰ.

Conclusion Targeted combination systematic biopsy can improve the accuracy of biopsy, although it will increase the incidence rate of moderate and severe hematoma, it is still a safe biopsy method.