Management of Benign Findings Following Local Anesthetic Transperineal Prostate Biopsy: A Single-Center Review and Comparison With Current Guidelines.

Introduction Although local anesthetic transperineal (LATP) prostate biopsy is now widely adopted, evidence remains limited, and no clear consensus exists on the optimal follow-up strategy for men with benign histology. This gap is particularly important given the increasing preference for LATP over the transrectal approach and the substantial proportion of patients who receive benign biopsy results. This study evaluated the follow-up of benign LATP biopsy findings and compared them with current international guidelines. Methods A retrospective analysis was conducted at Worcestershire Acute Hospitals NHS Trust on patients who underwent LATP biopsy between November 2023 and April 2024. Patients with benign histology were identified and categorized by follow-up strategy: monitored, discharged to primary care, underwent repeat biopsy, or unclear. Outcomes of repeat biopsies and associated clinical parameters were assessed. Results Of 616 patients, 206 (33.4%) had benign histology. Sixteen patients underwent repeat biopsy due to clinical or radiological suspicion. Among those re-biopsied, six (37.5%) were diagnosed with prostate cancer, including 2 (12.5%) with clinically significant disease (Gleason Grade Group ≥2). Immediate repeat biopsy detected cancer in 50% of cases, particularly in patients with inadequate initial sampling or Prostate Imaging-Reporting and Data System (PI-RADS) 5 lesions. Complication rates were low across the cohort, although three patients developed urosepsis. Conclusions LATP biopsy is safe and effective, but benign findings warrant structured follow-up due to a measurable false-negative rate. Our experience supports guideline recommendations that emphasize multidisciplinary evaluation, prostate-specific antigen kinetics, and imaging. Vigilant monitoring reduces the risk of missed cancers while avoiding unnecessary procedures.