True freehand transperineal prostate biopsy under local anesthesia: A prospective study for efficacy, safety, and tolerability in a tertiary care hospital.

INTRODUCTION

Prostate cancer remains a major cause of cancer mortality worldwide, with a rising incidence in Asia. Transrectal biopsy, though standard, carries the risks of infection, sepsis, and readmission. Transperineal (TP) biopsy under local anesthesia (LA) offers better safety. While grid-based and device-assisted methods are well established, a true freehand technique may be a cost-effective alternative in resource-limited settings.

MATERIALS AND

METHODS

In this prospective observational study (February 2023-January 2025), patients with elevated prostate-specific antigen (PSA), abnormal digital rectal examination, or Prostate Imaging Reporting and Data System (PI-RADS) ≥3 underwent TP biopsy using a true freehand technique under transrectal ultrasound guidance. Outcomes included pain (VAS), complications, and cancer detection rate.

STATISTICAL ANALYSIS: SPSS 26.0 software was used for analysis. The Chi-square and Friedman tests were applied. Multivariate regression was performed to determine odds ratios (ORs). P ≤ 0.05 was considered statistically significant.

RESULTS

One hundred and ten patients were biopsied (mean age: 66.2 ± 7.1 years; PSA 13.73 ± 7.68 ng/mL). PI-RADS 3, 4, and 5 lesions were found in 38.2%, 30.9%, and 30.9%, respectively. Most of the patients reported mild pain (VAS: ≤3), mainly during sampling. Minor complications included hematuria (25.4%), urinary retention (10%), and perineal hematoma (0.9%). No sepsis, readmissions, or Clavien-Dindo ≥ III events occurred. Clinically significant cancer was diagnosed in 61 (55.5%) patients. Gleason 4 + 5 was seen in 24 cases (39.9%). PI-RADS 4 (OR = 4.84) and 5 (OR = 6.64) were strongly associated with malignancy (P < 0.001).

CONCLUSION

True freehand TP prostate biopsy under LA is safe, well-tolerated, and diagnostically effective. It is a viable alternative to device-assisted methods, especially in resource-limited settings.