The Role of Freehand Transperineal Prostate Biopsy Under Local Anesthesia Without Antibiotics in Outpatient Settings.

The objectives of this study were to evaluate and compare the application of freehand transperineal prostate biopsy (FTPB) under local anesthesia (LA) versus systematic transperineal prostate biopsy (STPB) in an outpatient setting without antibiotics. A total of 218 biopsy-naive patients with suspicion of prostate cancer (PCa) based on multiparametric magnetic resonance imaging (mpMRI) were retrospectively analyzed. Suspicious areas on mpMRI were graded using the Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1). FTPB was performed for each suspicious lesion, followed by a 12-core STPB under LA. Histopathological outcomes, complications, and tolerability were recorded. The results showed that PCa was detected in 129 (59.17%) patients, with 104 (47.71%) being clinically significant prostate cancer (csPCa). There was agreement between FTPB and STPB in 94 (72.88%) patients. FTPB diagnosed fewer PCa cases but more csPCa cases than STPB. LA-FTPB was well-tolerated with no severe complications. The conclusions suggest that FTPB under LA in an outpatient setting without antibiotics is safe, feasible, and efficient.