{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:29:28Z","timestamp":1786649368341,"version":"build-2736575974"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>In this prospective observational study (February 2023\u2013January 2025), patients with elevated prostate-specific antigen (PSA), abnormal digital rectal examination, or Prostate Imaging Reporting and Data System (PI-RADS) \u22653 underwent TP biopsy using a true freehand technique under transrectal ultrasound guidance. Outcomes included pain (VAS), complications, and cancer detection rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Statistical Analysis:<\/jats:title>\n                    <jats:p>\n                      SPSS 26.0 software was used for analysis. The Chi-square and Friedman tests were applied. Multivariate regression was performed to determine odds ratios (ORs).\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2264 0.05 was considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      One hundred and ten patients were biopsied (mean age: 66.2 \u00b1 7.1 years; PSA 13.73 \u00b1 7.68 ng\/mL). PI-RADS 3, 4, and 5 lesions were found in 38.2%, 30.9%, and 30.9%, respectively. Most of the patients reported mild pain (VAS: \u22643), mainly during sampling. Minor complications included hematuria (25.4%), urinary retention (10%), and perineal hematoma (0.9%). No sepsis, readmissions, or Clavien\u2013Dindo \u2265 III events occurred. Clinically significant cancer was diagnosed in 61 (55.5%) patients. Gleason 4 + 5 was seen in 24 cases (39.9%). PI-RADS 4 (OR = 4.84) and 5 (OR = 6.64) were strongly associated with malignancy (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ua.ua_119_25","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T14:00:30Z","timestamp":1775829630000},"page":"162-170","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["True freehand transperineal prostate biopsy under local anesthesia: A prospective study for efficacy, safety, and tolerability in a tertiary care hospital"],"prefix":"10.4103","volume":"18","author":[{"given":"Amitayu","family":"Jana","sequence":"first","affiliation":[{"name":"Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debansu","family":"Sarkar","sequence":"additional","affiliation":[{"name":"Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"R1-20260415","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.prnil.2023.11.003","article-title":"Shifting to transperineal prostate biopsy: A narrative review","volume":"12","author":"Chung","year":"2024","journal-title":"Prostate Int"},{"key":"R2-20260415","doi-asserted-by":"crossref","first-page":"102719","DOI":"10.1016\/j.canep.2024.102719","article-title":"Understanding current trends and incidence projections of prostate cancer in India: A comprehensive analysis of national and regional data from the global burden of disease study (1990 \u20132021)","volume":"94","author":"Kumar","year":"2025","journal-title":"Cancer Epidemiol"},{"key":"R3-20260415","doi-asserted-by":"crossref","first-page":"2","DOI":"10.5334\/aogh.2607","article-title":"Survival rate of prostate cancer in Asian countries: A systematic review and meta-analysis","volume":"86","author":"Hassanipour","year":"2020","journal-title":"Ann Glob Health"},{"key":"R4-20260415","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/S0022-5347(17)38491-4","article-title":"Prostate specific antigen: A critical assessment of the most useful tumor marker for adenocarcinoma of the prostate","volume":"145","author":"Oesterling","year":"1991","journal-title":"J Urol"},{"key":"R5-20260415","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.euo.2020.12.004","article-title":"Positive predictive value of prostate imaging reporting and data system version 2 for the detection of clinically significant prostate cancer: A systematic review and meta-analysis","volume":"4","author":"Mazzone","year":"2021","journal-title":"Eur Urol Oncol"},{"key":"R6-20260415","doi-asserted-by":"crossref","first-page":"170","DOI":"10.22465\/kjuo.2020.18.3.170","article-title":"Expert group consensus opinion on prostate cancer diagnosis and management in India: Part 1 of 2","volume":"18","author":"Ghose","year":"2020","journal-title":"Korean J Urol Oncol"},{"key":"R7-20260415","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.eururo.2016.08.004","article-title":"Complications after systematic, random, and image-guided prostate biopsy","volume":"71","author":"Borghesi","year":"2017","journal-title":"Eur Urol"},{"key":"R8-20260415","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.urology.2016.12.011","article-title":"Prostate biopsy-related infection: A systematic review of risk factors, prevention strategies, and management approaches","volume":"104","author":"Roberts","year":"2017","journal-title":"Urology"},{"key":"R9-20260415","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.eururo.2012.04.044","article-title":"Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: Time to reassess antimicrobial prophylaxis?","volume":"62","author":"Carignan","year":"2012","journal-title":"Eur Urol"},{"key":"R10-20260415","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.5152\/tud.2020.20358","article-title":"Transperineal prostate biopsy: The modern gold standard to prostate cancer diagnosis","volume":"47","author":"Ortner","year":"2021","journal-title":"Turk J Urol"},{"key":"R11-20260415","first-page":"308","article-title":"Needle biopsy in diagnosis of prostatic cancer","volume":"81","author":"Kaufman","year":"1954","journal-title":"Calif Med"},{"key":"R12-20260415","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1089\/end.2020.1093","article-title":"Free-hand transperineal prostate biopsy under local anesthesia: Review of the literature","volume":"35","author":"Szabo","year":"2021","journal-title":"J Endourol"},{"key":"R13-20260415","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.urolonc.2006.03.003","article-title":"Improved prostate cancer detection with anterior apical prostate biopsies","volume":"24","author":"Wright","year":"2006","journal-title":"Urol Oncol"},{"key":"R14-20260415","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1038\/s41391-023-00714-x","article-title":"Histopathological concordance between prostate biopsies and radical prostatectomy specimens-implications of transrectal and transperineal biopsy approaches","volume":"27","author":"Hagens","year":"2024","journal-title":"Prostate Cancer Prostatic Dis"},{"key":"R15-20260415","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1038\/s41391-020-0204-8","article-title":"TREXIT 2020: Why the time to abandon transrectal prostate biopsy starts now","volume":"23","author":"Grummet","year":"2020","journal-title":"Prostate Cancer Prostatic Dis"},{"key":"R16-20260415","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1111\/bju.15985","article-title":"Transperineal magnetic resonance imaging\/transrectal ultrasonography fusion prostate biopsy under local anaesthesia: The \u2018double-freehand\u2019 technique","volume":"131","author":"Kaneko","year":"2023","journal-title":"BJU Int"},{"key":"R17-20260415","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s00345-019-02837-0","article-title":"Antibiotic resistance, hospitalizations, and mortality related to prostate biopsy: First report from the Norwegian Patient Registry","volume":"38","author":"Johansen","year":"2020","journal-title":"World J Urol"},{"issue":"Suppl 3","key":"R18-20260415","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/bju.13165","article-title":"Is transperineal prostate biopsy more accurate than transrectal biopsy in determining final Gleason score and clinical risk category? A comparative analysis","volume":"116","author":"Scott","year":"2015","journal-title":"BJU Int"},{"key":"R19-20260415","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.urpr.2015.05.007","article-title":"Ultrasound guided, freehand transperineal prostate biopsy: An alternative to the transrectal approach","volume":"3","author":"DiBianco","year":"2016","journal-title":"Urol Pract"},{"key":"R20-20260415","doi-asserted-by":"crossref","first-page":"16089","DOI":"10.1038\/srep16089","article-title":"Comparison between ultrasound guided transperineal and transrectal prostate biopsy: A prospective, randomized, and controlled trial","volume":"5","author":"Guo","year":"2015","journal-title":"Sci Rep"},{"key":"R21-20260415","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s00345-018-02622-5","article-title":"Controversies in MR targeted biopsy: Alone or combined, cognitive versus software-based fusion, transrectal versus transperineal approach?","volume":"37","author":"Marra","year":"2019","journal-title":"World J Urol"},{"key":"R22-20260415","doi-asserted-by":"crossref","first-page":"326","DOI":"10.4103\/0970-1591.85428","article-title":"Pathological outcomes and strategies to achieve optimal cancer control during robotic radical prostatectomy in Asian-Indian men","volume":"27","author":"Tewari","year":"2011","journal-title":"Indian J Urol"},{"key":"R23-20260415","doi-asserted-by":"crossref","first-page":"34","DOI":"10.4103\/iju.iju_222_21","article-title":"Safety and feasibility of freehand transperineal prostate biopsy under local anesthesia: Our initial experience","volume":"38","author":"Sivaraman","year":"2022","journal-title":"Indian J Urol"},{"key":"R24-20260415","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1097\/JU.0000000000000156","article-title":"Transperineal prostate biopsies using local anesthesia: Experience with 1,287 patients. Prostate cancer detection rate, complications and patient tolerability","volume":"201","author":"Stefanova","year":"2019","journal-title":"J Urol"},{"key":"R25-20260415","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.2147\/CMAR.S350701","article-title":"Comparison of MRI\/US fusion targeted biopsy and systematic biopsy in biopsy-na\u00efve prostate patients with elevated prostate-specific antigen: A diagnostic study","volume":"14","author":"Huang","year":"2022","journal-title":"Cancer Manag Res"},{"key":"R26-20260415","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.eururo.2019.06.023","article-title":"Prostate magnetic resonance imaging, with or without magnetic resonance imaging-targeted biopsy, and systematic biopsy for detecting prostate cancer: A cochrane systematic review and meta-analysis","volume":"77","author":"Drost","year":"2020","journal-title":"Eur Urol"},{"key":"R27-20260415","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1097\/JU.0000000000001902","article-title":"Freehand versus grid-based transperineal prostate biopsy: A comparison of anatomical region yield and complications","volume":"206","author":"Urkmez","year":"2021","journal-title":"J Urol"},{"key":"R28-20260415","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann Surg"},{"key":"R29-20260415","doi-asserted-by":"crossref","first-page":"229","DOI":"10.4103\/iju.iju_36_24","article-title":"Factors influencing urinary retention following freehand transperineal prostate biopsy: Insights from a tertiary care center study","volume":"40","author":"Agrawal","year":"2024","journal-title":"Indian J Urol"},{"key":"R30-20260415","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.urology.2018.01.021","article-title":"Initial experience performing in-office ultrasound-guided transperineal prostate biopsy under local anesthesia using the precisionpoint transperineal access system","volume":"115","author":"Meyer","year":"2018","journal-title":"Urology"},{"key":"R31-20260415","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/S0022-5347(09)61990-X","article-title":"Incidence of complications following prostate biopsy according to different preparation protocols","volume":"181","author":"Moussa","year":"2009","journal-title":"J Urol"},{"key":"R32-20260415","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s00345-018-2390-8","article-title":"Factors influencing urinary retention after transperineal template biopsy of the prostate: Outcomes from a regional cancer centre","volume":"37","author":"Kum","year":"2019","journal-title":"World J Urol"},{"key":"R33-20260415","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1177\/1875974212465573","article-title":"Urinary retention following transperineal template prostate biopsy-study of risk factors","volume":"6","author":"Willis","year":"2013","journal-title":"J Clin Urol"},{"key":"R34-20260415","doi-asserted-by":"crossref","first-page":"62","DOI":"10.4103\/1008-682X.173453","article-title":"Transperineal prostate biopsies for diagnosis of prostate cancer are well tolerated: A prospective study using patient-reported outcome measures","volume":"19","author":"Wadhwa","year":"2017","journal-title":"Asian J Androl"},{"key":"R35-20260415","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1111\/bju.15039","article-title":"Comparison of complications after transrectal and transperineal prostate biopsy: A national population-based study","volume":"126","author":"Berry","year":"2020","journal-title":"BJU Int"},{"key":"R36-20260415","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/JU.0000000000002251","article-title":"Infection rate after transperineal prostate biopsy with and without prophylactic antibiotics: Results from a systematic review and meta-analysis of comparative studies","volume":"207","author":"Castellani","year":"2022","journal-title":"J Urol"},{"key":"R37-20260415","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/S0090-4295(02)02551-7","article-title":"Best approach for prostate cancer detection: A prospective study on transperineal versus transrectal six-core prostate biopsy","volume":"61","author":"Emiliozzi","year":"2003","journal-title":"Urology"},{"key":"R38-20260415","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.eururo.2020.10.019","article-title":"European Association of Urology position paper on the prevention of infectious complications following prostate biopsy","volume":"79","author":"Pilatz","year":"2021","journal-title":"Eur Urol"}],"container-title":["Urology Annals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ua.ua_119_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:53:14Z","timestamp":1786647194000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ua.ua_119_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":38,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ua.ua_119_25","relation":{},"ISSN":["0974-7796","0974-7834"],"issn-type":[{"value":"0974-7796","type":"print"},{"value":"0974-7834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-08-04","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-06","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}