How to cite: Bryant RJ. “Transrectal Biopsy Versus Local Anaesthetic Transperineal Biopsy Evaluation (TRANSLATE) in Prostate Cancer Detection.” October, 2025. Accessed Oct 2026. https://grandroundsinurology.com/transrectal-biopsy-versus-local-anaesthetic-transperineal-biopsy-evaluation-translate-in-prostate-cancer-detection/
Summary
Richard J. Bryant, MBChB, PhD, FRCS, Professor of Urology, University of Oxford, Oxford, United Kingdom, describes the long-standing use of transrectal ultrasound-guided biopsy under local anesthetic and the growing trend toward local anesthetic transperineal biopsy, driven by concerns about sepsis and antibiotic resistance. He notes that observational data suggest a lower infection risk with transperineal routes, but robust randomized evidence is limited. The Transrectal Biopsy Versus Local Anesthetic Transperineal Biopsy Evaluation (TRANSLATE) trial is designed to provide definitive comparative data within a magnetic resonance imaging (MRI)-based pathway.
He explains that TRANSLATE is a pragmatic multicentre randomized controlled trial in the United Kingdom. Biopsy naive men with a raised prostate-specific antigen (PSA) or abnormal examination undergo pre-biopsy MRI and then randomization to local anesthetic transperineal biopsy without planned antibiotic prophylaxis, or standard of care transrectal biopsy with antibiotics. Both arms employ the same sampling strategy, utilizing targeted and systematic cores, with the route of access as the primary difference. The main outcome is the detection of Grade Group 2 or higher prostate cancer in the intention-to-treat population, with secondary outcomes including infection complications, pain, embarrassment, functional scores, and health economics.
He reports that Grade Group 2 or higher detection is higher with local anesthetic transperineal biopsy than with transrectal biopsy in the primary analysis. This advantage persists across sensitivity analyses. Infection requiring hospital admission is less frequent after local anesthetic transperineal biopsy. Still, absolute numbers are small, and the study is not powered to show a statistically robust difference in rare events. Overall complication rates, urinary symptoms, and sexual function scores at four months are similar between groups. Patients more often describe local anesthetic transperineal biopsy as acutely painful and embarrassing, yet acceptability remains high in both arms.
Dr. Bryant highlights that TRANSLATE demonstrates a higher detection rate of clinically significant cancer with local anesthetic transperineal biopsy within an MRI-based pathway, with reassuringly low infection rates for both approaches. He notes that trial results inform guidelines and policy, but that route choice must still consider patient preferences, operator experience, and resource requirements.
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ABOUT THE AUTHOR
Richard J. Bryant, MBChB, PhD, FRCS, is a Professor of Urology at the University of Oxford in England and an Academic Director of the University’s Nuffield Department of Surgical Sciences, Surgical Intervention Trials Unit. Dr. Bryant specializes in the diagnosis and management of prostate cancer, with a focus on prostate cancer research. Additionally, Dr. Bryant is a Cancer Research UK Clinician Scientist Fellow and the Lead Clinician for the Vaccination in Prostate Cancer Clinical trial in Oxford. He also serves as Honorary Consultant Urologist at the Churchill Hospital in Oxford.
