MRI–ultrasound (MRI-US) fusion transperineal prostate biopsy has become increasingly adopted due to its enhanced diagnostic accuracy and ability to precisely target suspicious lesions within the prostate. Given the growing emphasis on outpatient procedures, especially in resource-limited healthcare settings, our centre adopted a local anaesthesia protocol for transperineal biopsy. This prospective cohort study aimed to evaluate the diagnostic yield and patient-reported outcomes of MRI-US fusion transperineal prostate biopsy performed under local anaesthesia at our centre.

A total of 234 men underwent MRI-US fusion transperineal prostate biopsy under local anaesthesia between 2021 and 2024 at our institution. All patients were followed for six months post-procedure. Outcomes assessed included overall and clinically significant cancer detection rates, as well as post-biopsy complications classified according to the Clavien-Dindo system. Patient-reported outcomes included post-procedural pain using the Visual Analogue Scale (VAS), changes in lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and satisfaction with the procedure using the Surgical Satisfaction Questionnaire-8 (SSQ-8). Descriptive statistics were applied.

The mean age of patients was 68.26 years (SD 5.79). The overall prostate cancer detection rate was 44.87%, with clinically significant cancer identified in 32.05% of cases. Hematuria was absent in 50.85% of patients; when present, it typically resolved within 1 to 14 days. Hematospermia occurred in 15.8% of patients, usually resolving within 1 to 3 months. Urinary retention was observed in 9.83% of patients, with a median catheter duration of 5 days. Post-biopsy fever was reported in 4.27% of cases, all of which were successfully managed with oral antibiotics in the outpatient setting; none required hospital admission. No Clavien-Dindo grade III or higher complications were reported. The median pain score reported was 1 (IQR 2), with 87.18% of patients indicating satisfaction or high satisfaction with pain control. Additionally, 82.05% and 81.62% of patients reported no worsening of LUTS or ED, respectively. Satisfaction with return to daily activities and physical exercise was reported by 93.6% and 87.18% of patients, respectively. Overall, 86.33% were satisfied or very satisfied with the procedure, and the majority expressed willingness to recommend the biopsy to others.

MRI-US fusion transperineal prostate biopsy under local anaesthesia is a safe, effective, and well-tolerated diagnostic technique with low complication rates and high patient satisfaction. In the context of limited access to elective general anaesthesia operating theatre time—particularly within Malaysian public healthcare settings—this outpatient approach offers a practical and resource-efficient solution for prostate cancer diagnosis.