Trans-perineal prostate biopsy-Prognostic factors for "no prostate tissue" in biopsy cores.

PURPOSE: To identify predictors of no prostate tissue (NPT) in trans-perineal (TP) prostate biopsy cores. METHODS: We conducted a prospective cohort study of patients undergoing TP biopsy at the University of Chicago between 2022 and 2023. All patients underwent systematic biopsy with or without targeted sampling. The primary endpoint was the presence of NPT in at least one biopsy core per session. Univariable and multivariable logistic regression analyses were performed to identify predictors of NPT. RESULTS: A total of 732 patients were included. A total of 215 patients (29%) had at least one biopsy core containing NPT. Patients with NPT had smaller prostate volumes, higher rates of prior focal therapy, and were more likely to undergo TP biopsy under local anesthesia. On univariable analysis, larger prostate volume (OR 0.92, 95% confidence intervals [CI] 0.86-0.97, P = 0.003) and Hispanic or other race/ethnicity (OR 0.58, 95% CI 0.33-0.98, P = 0.048) were associated with lower odds of NPT, whereas prior focal therapy (OR 3.20, 95% CI 1.43-7.34, P = 0.005) and TP biopsy performed under local anesthesia (OR 1.68, 95% CI 1.18-2.43, P = 0.005) were associated with higher odds. On multivariable analysis, higher PSA density (which inversely reflects prostate volume) (OR 8.87, 95% CI 1.31-73.5, P = 0.03), TP biopsy performed under local anesthesia (OR 1.95, 95% CI 1.31-2.96, P = 0.001), and sampling 3 targeted lesions (OR 2.85, 95% CI 1.44-5.69, P = 0.003) were independent predictors of NPT. CONCLUSION: NPT is common in TP prostate biopsy. Higher PSA density, TP biopsy performed under local anesthesia, and sampling 3 targeted lesions are independent predictors of NPT.