Erdem Öztürk

Background: To determine whether systematic biopsy can be safely omitted in selected patients undergoing antibiotic‐free transperineal cognitive MRI‐targeted prostate biopsy under local anesthesia, and to identify clinical and imaging parameters associated with cognitive biopsy superiority. Methods: This retrospective study included patients who underwent antibiotic‐free transperineal prostate biopsy under local anesthesia. All patients had multiparametric prostate MRI (mpMRI) visible lesions and received both systematic and cognitive MRI‐targeted biopsy. Targeted cores were obtained from all PI‐RADS 4–5 lesions and from PI‐RADS 3 lesions only when PSA density was ≥ 0.10 ng/mL/cm ³ . Cognitive biopsy non‐inferiority was defined as an ISUP Grade Group equal to or higher than that obtained from systematic cores in the same patients. PSA density, MRI lesion size, and PI‐RADS category were incorporated into a multivariable model to predict when systematic sampling would not add diagnostic value. Results: The multivariable model incorporating PSA density, MRI lesion size, and PI‐RADS category demonstrated good discriminatory performance (AUC 0.881, sensitivity 92.6%, specificity 84.8%). In patients meeting all predefined model criteria, cognitive biopsy achieved concordant or superior grading in 95.2% of cases, whereas in those not meeting these criteria, systematic biopsy provided higher‐grade detection in all cases within this subgroup. Conclusions: In carefully selected patients with elevated PSA density, larger mpMRI visible lesions, and high PI‐RADS scores, transperineal cognitive MRI‐targeted biopsy may support the selective omission of systematic cores without compromising diagnostic reliability. In contrast, systematic sampling remains indispensable in lower‐risk profiles, underscoring the value of a risk‐adapted biopsy strategy.

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This multi-center retrospective study aimed to compare the diagnostic efficacy, safety, and procedural feasibility of trans-perineal cognitive biopsy (TPC) and trans-rectal-MRI fusion biopsy (TRF), both performed under local anesthesia, in patients with suspected prostate cancer. A total of 634 biopsy-naïve patients with PI-RADS ≥3 lesions on multi-parametric MRI were included. Among them, 284 patients underwent TRF and 350 underwent TPC across two tertiary centers between January 2020 and May 2025. The primary endpoints included detection rates of clinically significant prostate cancer (csPCa) and biopsy-related complications. Secondary outcomes included overall cancer detection, proportion of clinically insignificant cancers, pain scores, and procedural feasibility under local anesthesia. Targeted versus systematic biopsy yield was additionally analyzed. Multivariable logistic regression analysis was performed to identify independent predictors of csPCa detection, adjusting for age, prostate volume, PSA density, PI-RADS score, and number of targeted cores. The csPCa detection rates were comparable between the TRF and TPC groups (30.3% vs. 27.4%, p = 0.430). TRF demonstrated a significantly higher overall cancer detection rate (60.2% vs. 44.0%, p < 0.001) but also a higher rate of clinically insignificant cancers (29.9% vs. 16.6%, p < 0.001). After stratification by PI-RADS category, csPCa detection rates remained comparable between the two techniques across PI-RADS 3, 4, and 5 lesions (all p > 0.05). In multivariable analysis, biopsy technique was not independently associated with csPCa detection (adjusted OR 0.93, 95% CI 0.68-1.27, p = 0.642), whereas higher PI-RADS score and PSA density were independent predictors. Infectious complications were more frequent in the TRF group (3.9% vs. 1.1%, p = 0.024), while urinary retention requiring catheterization occurred at similar rates between the two groups. Both procedures were well tolerated under local anesthesia, with no significant difference in pain scores. No prophylactic antibiotics were administered in the TPC group. Transperineal cognitive biopsy appears to offer comparable efficacy to trans-rectal-MRI fusion biopsy in detecting csPCa while potentially reducing unnecessary diagnoses and infectious complications. Given its comparable performance after risk adjustment and its feasibility under local anesthesia without the need for prophylactic antibiotics or fusion software, TPC may represent a viable alternative in selected clinical contexts. Further prospective research is warranted to confirm these findings and refine patient selection criteria.

Objectives: Transperineal prostate biopsy (TP‐Bx) is increasingly preferred due to its lower infection risk and improved clinically significant prostate cancer detection rates. Its feasibility under local anesthesia provides both clinical and economic advantages. However, acute urinary retention (AUR) remains a significant post‐procedure concern. This study aims to evaluate the impact of transperineal prostate biopsy performed under local anesthesia on voiding function using uroflowmetry parameters. Materials and Methods: A prospective observational study was conducted with 74 patients. TP‐Bx was performed under local anesthesia using a freehand technique. Uroflowmetry parameters, including maximum urinary flow rate ( Q _max , mL/s), average urinary flow rate ( Q _ave , mL/s), voided volume ( V _v , mL), and post‐void residual volume (PVR), were assessed before and after the procedure to evaluate its impact on voiding function. Results: The average changes in Q _max and Q _ave between pre and post procedure were 1.78 ± 4.33 and 0.63 ± 1.70, respectively. A significant reduction in Q _max and Q _ave was observed after TP‐Bx ( p < 0.001). PVR increased after TP‐Bx ( p < 0.001); however, these changes were mild and did not require catheterization. Conclusion: With increasing experience, TP‐Bx has become safer. The use of local anesthesia reduces anesthesia‐related complications, and the historically feared risk of AUR appears lower than previously assumed. These findings support TP‐Bx as a safe and effective diagnostic approach.

To explore the possible impact of real-time ultrasound screen visualization on pain perception, anxiety levels, and overall patient experience during trans