Modified Local Anesthesia for Transperineal Prostate Biopsy: A Comparative Study of Safety and Tolerability

Objective To evaluate the safety and tolerability of a modified local anesthesia (MLA) protocol for transperineal (TP) prostate biopsy and to compare its outcomes with general anesthesia (GA) and epidural block (EB).. Patients and Methods: This retrospective study analyzed 897 patients who underwent TP prostate biopsy between January 2021 and July 2024, all performed by the same experienced urologist. Patients were divided into three groups: MLA (n = 591), GA (n = 123), or EB (n = 183). Key metrics for evaluating safety and tolerability included the visual analog scale (VAS) for pain, incidence of complications, and the cancer detection rate. Results A total of 897 patients were analyzed (591 MLA, 123 GA, 183 EB). While the MLA group reported higher pain scores during anesthesia administration compared to the EB group (mean VAS 4.41 vs. 3.95, p < 0.001), severe pain (VAS ≥ 7) was infrequent (3.89%). Notably, the MLA group exhibited a lower incidence of early complications, including urinary retention (14.2% vs. 29.3% in GA and 29.5% in EB, p < 0.001) and fever (7.3% vs. 15.4% in GA and 13.7% in EB, p = 0.003). The overall prostate cancer (PCa) detection rate in the MLA group was 54.15%, indicating comparable diagnostic efficacy. Conclusion MLA for TP biopsy is a safe and well-tolerated procedure that reduces early postoperative complications compared to GA and EB, while maintaining high diagnostic accuracy. Therefore, MLA represents a robust alternative anesthetic strategy, offering a balance between patient comfort, safety, and clinical efficiency.