目前尚不清楚磁共振成像（MRI）引导的经会阴（TP）活检是否能够提高临床意义前列腺癌（csPCa）的检测率。本研究旨在比较MRI引导的TP活检和经直肠（TR）活检在csPCa检测方面的效果。我们通过PubMed/Medline、Embase和Web of Science数据库进行文献检索，筛选截至2023年2月发表的相关研究。在筛选过程中遵循《系统评价和Meta分析的首选报告项目（PRISMA）指南》的规定。主要观察指标为csPCa的检测率（格里森评分≥2）。我们采用敏感性分析方法，根据肿瘤定位、前列腺成像报告和数据系统（PI-RADS）评分以及融合类型（认知型或软件型）进行csPCa检测率的分析。共筛选出11项符合纳入标准的研究，回顾了3522例TR活检和5140例TP活检的患者数据。结果显示，TR活检和TP活检在csPCa检测方面的差异无统计学意义（比值比【OR】1.11，95%可信区间【CI】0.98-1.25；p = 0.1）。按病变位置分层分析发现，TP活检在前方（OR 2.17，95% CI 1.46-3.22；p < 0.001）和顶尖（OR 1.86，95% CI 1.14-3.03；p = 0.01）病变的csPCa检测上具有更高的检出率。在基于PI-RADS评分的亚组分析中，TP活检在PI-RADS 4病变的csPCa检测上也表现出更高的检出率（OR 1.57，95% CI 1.07-2.29；p = 0.02），而PI-RADS 3和5病变的检出率则无明显差异（p > 0.05）。主要限制是多数纳入研究采用回顾性设计。总体而言，我们并未发现前列腺活检方式与csPCa的检出率存在显著关联。TP活检在前方和顶尖病变方面具有较大的检出优势，因此在这些病变位置上更适合采用TP活检。综上所述，经会阴磁共振成像引导的前列腺活检方式似乎只对特定的病变较为有效，在整体人群中并未明显受益。版权所有 © 2023 欧洲泌尿外科协会。由Elsevier B.V.出版。保留所有权利。

It is unclear whether a magnetic resonance imaging (MRI)-targeted transperineal (TP) biopsy can improve the detection of clinically significant prostate cancer (csPCa).To compare the MRI-targeted TP and transrectal (TR) approaches for csPCa detection.A literature search was conducted using the PubMed/Medline, Embase, and Web of Science databases to identify reports published until February 2023. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The primary outcome was the detection of csPCa (Gleason grade group ≥2). Sensitivity analyses were performed to investigate csPCa detection rates according to tumor location, Prostate Imaging Reporting and Data System (PI-RADS) score, and type of fusion (cognitive or software based).Eleven studies met our inclusion criteria, and data from 3522 and 5140 patients who underwent, respectively, TR and TP MRI-targeted biopsies were reviewed. No statistically significant difference in the detection of csPCa was observed between the TR and TP approaches (odds ratio [OR] 1.11, 95% confidence interval [CI] 0.98-1.25; p = 0.1). When stratifying patients according to lesion location, the TP approach was associated with higher csPCa detection in case of anterior (OR 2.17, 95% CI 1.46-3.22; p < 0.001) and apical (OR 1.86, 95% CI 1.14-3.03; p = 0.01) lesions. In the subgroup analysis based on PI-RADS score, the TP approach was associated with higher csPCa detection (OR 1.57, 95% CI 1.07-2.29; p = 0.02) in PI-RADS 4 lesions. Conversely, no difference was found in PI-RADS 3 and 5 lesions (p > 0.05). The main limitation was the retrospective design of most included studies.No significant association was found between the prostate biopsy approach and csPCa detection rate when we considered all biopsy indications. The TP approach provides a detection advantage in anterior and apical tumors, arguing for a preferred use of the TP approach in these lesion locations.The transperineal magnetic resonance imaging-targeted prostate biopsy approach appears to be more effective only for selected lesions. No clear benefit was seen for the transperineal approach in the overall population.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.