Breaking News:Prostate Biopsy Under Local Anesthesia– What Just Happened

Prostate Biopsy Findings

PROSTATE biopsy under local anesthesia showed similar safety and detection outcomes, with better comfort trends for transperineal sampling.

A retrospective single center cohort study comparing local anesthetic transperineal biopsy and transrectal ultrasound biopsy found no statistically significant differences in overall complication rates, tolerability, or cancer detection. However, several patient reported measures favoured the transperineal approach, particularly during ultrasound probe use and biopsy gun deployment.

The study included 110 patients, with 55 undergoing local anaesthetic transperineal biopsy and 55 receiving transrectal ultrasound biopsy. Baseline characteristics were broadly comparable between groups, including age, prostate-specific antigen, prostate volume, PSA density, digital rectal examination findings, and median PI-RADS score.

Prostate Biopsy Tolerability and Complications

Both prostate biopsy techniques were completed successfully in all patients, with no procedures abandoned. Pain scores for baseline discomfort, local anaesthetic infiltration, and immediate recovery were similar between groups. However, patients undergoing transrectal ultrasound biopsy reported significantly higher pain scores during ultrasound probe insertion and biopsy gun deployment.

Complication rates were also comparable. Difficulty passing urine was reported in 9% of patients after local anaesthetic transperineal biopsy versus 16% after transrectal ultrasound biopsy. Haematuria occurred in 58% and 73% of patients, respectively. One urinary tract infection was reported in the transrectal group and was managed in the community with oral antibiotics. No patient required hospital admission, and no severe complications were observed.

Patient acceptance was notable in the transperineal cohort. All patients in this group said they would be willing to undergo the procedure again if needed. Among those with previous biopsy experience, most who later underwent local anaesthetic transperineal biopsy described it as superior to prior procedures.

Cancer Detection in Prostate Biopsy

Cancer detection rates were numerically higher with local anaesthetic transperineal biopsy, although the difference did not reach statistical significance. Overall cancer was detected in 58.2% of the transperineal group compared with 47.3% of the transrectal group. In patients with PI-RADS 4 or 5 lesions, detection was 81.4% versus 64.2%, again without a statistically significant difference.

The authors concluded that local anaesthetic transperineal biopsy is safe compared with transrectal ultrasound biopsy across procedure tolerability, complications, and cancer detection. While larger multicenter studies are still needed, these findings support local anesthetic transperineal biopsy as a promising approach in the diagnosis of prostate cancer.

Reference
Lim P et al. The evolution of prostate biopsy: a retrospective comparison of transperineal and transrectal approaches under local anaesthesia. Cureus. 2026;DOI:10.7759/cureus.103547.