Effect of Anesthesia Type on Clinically Significant Prostate Cancer Detection in Transperineal MRI-Targeted Biopsy

Background/Objectives: The transperineal approach is the recommended standard for prostate biopsy. We aimed to determine whether anesthesia type—local anesthesia (LA) versus general anesthesia (GA)—independently influences clinically significant prostate cancer (csPCa) detection in transperineal magnetic resonance imaging (MRI)-targeted biopsy and to evaluate its impact on biopsy–prostatectomy pathological concordance. Methods: This single-center retrospective study included biopsy-naive men undergoing cognitive-fusion transperineal prostate biopsy under LA or GA. Propensity score matching (1:1) was performed on age, prostate-specific antigen, PI-RADS score, and prostate volume. The primary outcome was csPCa detection (ISUP Grade Group ≥ 2) on combined systematic and targeted biopsy. Secondary outcomes included overall and high-grade cancer detection and biopsy–prostatectomy pathological concordance. Results: After matching, 220 pairs (440 patients) were analyzed. csPCa detection on combined biopsy did not differ between LA and GA (40.5% vs. 37.7%, p = 0.625; absolute risk difference −2.7 percentage points, 95% CI −11.8 to 6.4; relative risk 0.93, 95% CI 0.74–1.18), nor did overall (54.5% vs. 55.0%, p = 1.000) or high-grade cancer detection (21.4% vs. 24.1%, p = 0.569). Similarly, no significant differences were observed for systematic biopsy alone (csPCa: 36.4% vs. 34.5%, p = 0.765) or targeted biopsy alone (csPCa: 35.9% vs. 35.0%, p = 0.921). Subgroup and multivariable analyses showed that anesthesia type was not an independent predictor of csPCa (adjusted odds ratio 0.887, 95% CI 0.553–1.423, p = 0.620). Biopsy–prostatectomy pathological concordance did not differ significantly between groups in the 121 prostatectomy patients. Conclusions: Anesthesia type was not significantly associated with csPCa detection in transperineal cognitive-fusion biopsy, and pathological concordance was similar between LA and GA. These findings support the feasibility of LA transperineal biopsy, although the confidence intervals do not establish formal equivalence between the two approaches.