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: ≤ 0.05 was considered statistically significant. Results: < 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.