***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: R and om systematic ultrasound guided transrectal core biopsies of the prostate were compared to directed biopsies of specific hypoechoic defects in 136 men with abnormal prostates on digital rectal examination . Prostate cancer was diagnosed in 83 of 136 patients ( 62 per cent ) . In 80 of 83 individuals ( 94 per cent ) the cancer was detected by r and om systematic biopsies alone . Of 57 men in whom r and om systematic and directed biopsies were obtained the results of biopsy agreed in 86 per cent , while in 9 per cent r and om systematic biopsies found cancers missed by directed biopsies and in 5 per cent directed biopsies diagnosed cancers missed by r and om systematic prostate biopsies . Ultrasound guided r and om systematic biopsy is simple and easily learned . When combined with additional directed biopsies of the rare hypoechoic areas not included in the pattern of systematic sampling , it provides a highly accurate means to diagnose prostate cancer , minimizing observer and sampling errors . This technique of prostate mapping with 6 , 1.5 cm . cores provides valuable additional information on cancer volume , Gleason grade and the potential location of surgically positive margins , all without compromising the operation or the chance for a surgical cure To evaluate the value of multiparametric magnetic resonance imaging ( mpMRI ) in the detection of significant prostate cancer ( PCa ) and to compare transperineal MRI/ultrasonography fusion biopsy ( fusPbx ) with conventional transrectal systematic biopsy ( sysPbx ) in biopsy‐naïve patients & NA ; The detection rate for clinical ly significant prostate cancer ( PCa ) of transperineal ( TP ) versus transrectal ( TR ) multiparametric ( mp ) magnetic resonance imaging (MRI)/transrectal ultrasound‐guided ( TRUS ) fusion targeted biopsy has been prospect ively evaluated in 200 men su bmi tted to repeat TP saturation prostate biopsy . mpMRI/TRUS TP cognitive targeted biopsy found a greater percentage of clinical ly significant PCa of the anterior zone compared to the mpMRI/TRUS TR fusion approach ( 93.3 vs. 25 % ) . Introduction : To evaluate the detection rate for clinical ly significant prostate cancer ( PCa ) of transperineal ( TP ) versus transrectal ( TR ) multiparametric ( mp ) magnetic resonance imaging (MRI)/transrectal ultrasound‐guided ( TRUS ) fusion targeted biopsy . Patients and Methods : From January 2015 to January 2016 , a total of 200 men ( median age , 61 years ) with negative digital rectal examination findings underwent repeat saturation TP prostate biopsy ( SPBx ; median 30 cores ) for increasing or persistent elevated prostate‐specific antigen values . Ten day before SPBx , all patients underwent 3.0 T pelvic mpMRI ( Achieva 3 T ; Philips Healthcare Best , Netherl and s ) . In the presence of mpMRI lesions suggestive of cancer ( Prostate Imaging — Reporting and Data System [ PI‐RADS ] score 4/5 ) , targeted mpMRI/TRUS TR fusion guided biopsies ( 4 cores ) and TP cognitive biopsies ( 4 cores ) were added to SPBx . Results : Median prostate‐specific antigen was 8.6 ng/mL , and mpMRI revealed a suspicious lesion in 95 ( 47.5 % ) of 200 cases . Overall , in 60 ( 30 % ) of 200 men , a clinical ly significant PCa was found , and in all cases , mpMRI was positive . SPBx , TR fusion , and mpMRI/TRUS TP cognitive targeted biopsy diagnosed 59 ( 98.3 % ) , 40 ( 78.3 % ) , and 56 ( 93.3 % ) clinical ly significant PCa , respectively . TR fusion versus TP targeted biopsy missed 12 versus 1 ( P = .001 ) cancers of the anterior zone and 8 versus 3 ( P = .12 ) cancers of the peripheric gl and , respectively ; moreover , PCa diagnosed by TR fusion versus TP targeted biopsy had a mpMRI lesion diameter and percentage of positive cores equal to 13 versus 10 mm and 33 % versus 58 % ( P = .001 ) , respectively . Conclusion : mpMRI/TRUS TP cognitive targeted biopsy found a greater percentage of clinical ly significant PCa of the anterior zone compared to the mpMRI/TRUS TR fusion approach ( 93.3 % vs. 25 % ; P = .0001 ) This prospect i ve study of comparing transperineal prostate biopsy ( TPBx ) with transrectal prostate biopsy ( TRBx ) was aim ed to provide evidence for clinicians to select the appropriate biopsy approach under different conditions . TPBx ( n = 173 ) and TRBx ( n = 166 ) were performed r and omly for 339 patients who were suspicious of prostate cancer ( PCa ) . The cancer detection rate ( CDR ) , complication rate , visual analogue scale ( VAS ) score , most painful procedure , number of repeated biopsy and additional anesthesia , and operating time ( starting from lying down on the operating table to getting up ) were recorded . The results showed that TPBx and TRBx were equivalent in CDR ( 35.3 % vs. 31.9 % ) and minor complication rate ( 44.9 % vs. 41.0 % ) ( both P > 0.05 ) . The major complication rate was lower in TPBx than in TRBx ( 0.6 % vs. 4.3 % , P < 0.05 ) . TPBx was more time-consuming ( 17.51 ± 3.33 min vs. 14.73 ± 3.25 min ) and painful ( VAS score : 4.0 vs. 2.0 ) ; and it had higher rates of repeated biopsy ( 3.2 % vs. 1.1 % ) and additional anesthesia ( 15.0 % vs. 1.2 % ) ( all P < 0.05 ) . In summary , both TPBx and TRBx are effective to detect PCa . The major complication rate for TRBx is higher , whereas TPBx procedure is more complex and painful BACKGROUND The ideal bioptic strategy for CaP detection is still to be completely defined . The aim of our study is to compare transperineal ( TP ) and transrectal ( TR ) approaches , in a 14-core initial prostate biopsy for CaP detection . MATERIAL AND METHODS A prospect i ve controlled study was conducted enrolling 108 consecutive patients with a PSA level greater than 4 ng/mL and /or an abnormal DRE .  TR versus TP 14-core initial prostatic biopsies were performed on 54 and 54 patients , respectively , with a r and omisation ratio of 1:1 . RESULTS The cancer detection rates were 46.29 ( 25 out of 54 patients ) , and 44.44 % ( 24 out of 54 patients ) , respectively , using the TR or the TP approach ( p = 0.846 ) . The overall cancer core rate was significantly higher when the TP approach was used : 21.43 % ( 162 out of 756 cores ) and 16.79 % ( 127 out of 756 cores ) , with the TP and the TR approach , respectively ( p = 0.022 ) . The cores were significantly longer performing TP approach : at the site " 1 " ( 14.92 versus 12.97 mm , p = 0.02 ) ; at " 5 " ( 15.53 versus 13.69 mm , p = 0.037 ) ; at " 7 " ( 15.06 versus 12.86 mm , p = 0.001 ) ; at " 9 " ( 14.92 versus 13.38 mm , p = 0.038 ) ; at " 11 " ( 16.32 versus 12.31 mm , p = 0.0001 ) ; at " 12 " ( 15.14 versus 12.19 mm , p = 0.0001 ) ; at " 13 " ( 17.49 versus 13.98 mm , p = 0.0001 ) ; at " 14 " ( 16.77 versus 13.36 mm , p = 0.0001 ) . As to the biopsy related pain , the mean pain level perceived by patients during the TR approach was 1.56 ± 1.73 versus 1.42 ± 1.37 registered during TP approach ( p = 0.591 ) . CONCLUSIONS No significant differences were found in cancer detection rate , cancer core rate between TP and TR approaches for prostatic biopsy . Even in terms of complication rate or pain level , it can not be concluded that one procedure is superior to the other one . Apparently , strictly following our protocol , TP approach seems to offer a better sampling at the level of the apex and the TZ , however without adding any significant advantage in terms of overall cancer detection rate OBJECTIVES Transperineal and transrectal prostate biopsy are both used for prostate cancer detection . However , which approach is superior remains unknown . In this study , we performed a prospect i ve r and omized study to compare the efficacy of transperineal versus transrectal 12-core initial prostate biopsy . METHODS From May 2003 to October 2005 , a prospect i ve r and omized study of  transperineal versus transrectal 12-core biopsy ( 126 and 120 patients , respectively ) was conducted in 246 patients with a prostate-specific antigen level of 4.0 to 20.0 ng/mL. All procedures were performed with the patient in the lithotomy position , with the transperineal and transrectal approach performed with spinal anesthesia ( 0.5 % bupivacaine ) or a caudal block ( 1 % lidocaine ) , respectively . With both approaches , eight biopsy specimens were obtained systematic ally from the peripheral zone , including the apex , and four from the transition zone . RESULTS The cancer detection rate was 42.1 % ( 53 of 126 patients ) with the transperineal approach and 48.3 % ( 58 of 120 patients ) with the transrectal approach ( P = 0.323 ) . For all patients undergoing transperineal and transrectal biopsy , the cancer core rate ( cancer core number/biopsy core number ) was 13.7 % ( 207 of 1512 cores ) and 14.4 % ( 208 of 1440 cores ) , respectively ( P = 0.566 ) . Apart from headache , presumably related to the spinal anesthesia , no significant differences were found in the complications between the two groups . CONCLUSIONS No significant differences were found in the cancer detection rate , cancer core rate , or complications between the two approaches . We believe that the preferred approach as an initial prostate biopsy is the transrectal approach , which does not require spinal anesthesia or another burdensome process OBJECTIVES Magnetic resonance imaging ( MRI ) and transrectal sonography are the two accepted imaging modalities for evaluation of perianal fistulas and abscesses .  Transperineal sonography is a new technique that is easy to learn and can be performed at any time . The purpose of this study was to prospect ively compare the diagnostic accuracy of MRI , transrectal sonography , and transperineal sonography with surgical findings in patients with perianal Crohn disease . METHODS All patients with perianal Crohn disease underwent MRI , transrectal sonography , and transperineal sonography within a few days before surgery . Fistulas were classified as simple ( 43.8 % ) or complex ( 52.2 % ) based on surgical findings . RESULTS Twenty-three patients with active perianal Crohn disease ( 12 women and 11 men ; mean age , 29.9 years ; current therapy : antibiotics , 69.6 % ; azathioprine , 56.5 % ; and biologics , 73.9 % ; previous surgery , 26.1 % ; and proportion of smokers , 39.1 % ) were included . Sensitivity values for MRI , transrectal sonography , and transperineal sonography  for diagnosis of fistulas were 84.6 % , 84.6 % , and 100 % , respectively . Transperineal sonography was more sensitive for diagnosis of perianal abscesses than MRI and transrectal sonography ( 100 % , 58.8 % , and 92.8 % ) . CONCLUSIONS Transperineal sonography is a very accurate diagnostic method with outst and ing sensitivity compared with MRI and transrectal sonography for evaluation of complicated perianal Crohn disease . Due to its simplicity and low cost , it is recommended that transperineal sonography be the first diagnostic modality in these cases The aim of this study is to eluci date the diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy for prostate cancer . We prospect ively r and omized 200 consecutive men into two groups to undergo  systematic prostate biopsy .  Overall positivity for cancer was similar ( 47 % by transperineal and 53 % by transrectal ; P=0.480 ) . However , in case with ‘ gray zone ’ PSA ( from 4.1 to 10.0 ng/ml ) , significantly more cores were positive when approach was transperineal , especially among transition zone cores . Therefore , urologist preferences are sufficient for choosing an approach , except for a possible small advantage of trans 
    Output:
    
The condensed relative risk of 11 included studies indicated that transperineal prostate biopsy has the same diagnosis accuracy of transrectal prostate biopsy ; however , a significantly lower risk of fever and rectal bleeding was reported for transperineal prostate biopsy .
Short conclusion To conclude , this review indicated that transperineal and transrectal prostate biopsy have the same diagnosis accuracy , but the transperineal approach has a lower risk of fever and rectal bleeding .