Evaluating prostate biopsy practices across Indian institutions: A multi-center prospective observational study.

Background: Prostate cancer is the second most common malignancy globally amongst men. While prostate-specific antigen (PSA) screening aids in early detection, prostate biopsy remains the diagnostic gold standard. However, the biopsy practices vary widely across various Indian centers. This study aimed to evaluate the current biopsy techniques, indications, complications, and diagnostic yield across multiple institutions. Methods: A prospective, multi-center observational study was conducted from June 14, 2023, to June 14, 2024, under the Urological Society of India Collaborative Research Committee. Data from 2479 patients across 43 institutions were collected using a standardized template. Men aged ≥40 years undergoing initial or repeat biopsies were included. Variables included demographics, PSA levels, imaging, biopsy route and technique, antibiotic prophylaxis, pain scores, complications, and histopathology. Analysis was performed using SPSS v23. Results: Elevated PSA was the primary indication of biopsy in 95.2% of the patients (median: 19.8 ng/ml). The transrectal route was used in 91.8% of the patients whereas the transperineal was used in 6.4%. Multiparametric magnetic resonance imaging was performed in 45%, with targeted cores in 15.6% of the patients. PIRADS 5 lesions had a cancer detection rate (CDR) of 81.4%, while PIRADS 2 had CDR of 23.1%; no cancers were found in PIRADS 2 lesions in repeat biopsy settings. Adenocarcinoma was diagnosed in 61% of the patients. Transrectal biopsies had a higher CDR (61.3% vs. 47.2%; P < 0.05) but also higher infection rates (3.3% vs. 0%; P = 0.03). Overall complication rate was 11%, with hematuria >1 day being the most common (6.5%) complication. Conclusion: This large, multi-institutional study highlights significant variability in prostate biopsy practices in India and emphasizes the need for standardized training to improve the diagnostic outcomes and safety.