How to cite: Lamb, Alastair D. “State of the Art and Future Directions in Prostate Biopsies: Urological Perspective.” September 15, 2025. Accessed Dec 2025. https://grandroundsinurology.com/state-of-the-art-and-future-directions-in-prostate-biopsies-urological-perspective/
Alastair D. Lamb, MA, MBChB, PhD, FRCS, Senior Clinical Lecturer, Barts Cancer Institute, London, UK, reviews new randomized trial evidence comparing transrectal (TRUS) and transperineal (LATP/TP) prostate biopsy approaches. Dr. Lamb notes how the last 18 months have been pivotal for prostate biopsy practice. While traditionally biopsies have been performed via the transrectal route using ultrasound guidance, concerns about infection risk led to a UK movement (the “TREXIT” campaign) advocating widespread adoption of the transperineal (TP) approach.
Four randomized trials (ProBE-PC, PREVENT, PERFECT, TRANSLATE) provide high-level evidence. ProBE-PC and PREVENT found no significant differences in infection rates between TRUS and TP. PERFECT, a small underpowered trial, suggested TP might miss posterior lesions. TRANSLATE, co-led by Dr. Lamb, demonstrated higher detection of clinically significant cancers and lower infection rates with LATP, but also greater patient discomfort and higher costs in the NHS. Overall, guidelines now lean toward TP biopsy.
Dr. Lamb provides technical tips for LATP, emphasizing careful preparation to avoid air bubbles, optimal local anesthetic administration, angulation (not rotation) with precision point guides, and strategies to overcome rectal gas interference. He highlights the importance of cognitive targeting using MRI maps and the “rectal dip” technique for apical lesions.
Looking ahead, Dr. Lamb’s group is applying spatial transcriptomics to prostate specimens, revealing that single biopsies may sample multiple tumor clones with distinct biology. MRI may eventually help identify aggressive clones noninvasively.
Dr. Lamb shares that TP biopsy will likely become standard, but clinicians must perfect the technique and remain open to future innovations in molecular and AI-guided diagnostics.
The Global Summit on Precision Diagnosis and Treatment of Prostate Cancer is a unique multi-disciplinary forum organized to inform the key health care stakeholders about the emerging advances in clinical cases and research and create a consensus-based vision for the future of precision care and educational and research strategy for its realization. The mission of the Summit is to fill the currently existing gap between the key experts of in vivo imaging, the world authorities in the in vitro fluid- and tissue-based molecular diagnostics, including genomics, and thought leaders in the development of novel observation strategies (e.g., active surveillance, or AS) and therapeutic interventions.
ABOUT THE AUTHOR
Alastair D. Lamb, MA, MBChB, PhD, FRCS, is a Senior Clinical Lecturer at the Barts Cancer Institute in London, England. Dr. Lamb also serves as a Visiting Associate Professor and Consultant Urological Surgeon at Oxford University in England. His clinical interest includes developments relating to minimal access surgery (MIS) surgery and simulated training, and in investigating the role of robotic surgery in locally advanced or metastatic disease. Dr. Lamb’s lab focuses on spatial clonal biology to unpack prostate cancer heterogeneity, with a focus on identifying and defining clonal lethality.
