From Theater to Clinic: A Retrospective Evaluation of Local Anesthetic Transperineal Biopsy for the Rapid Diagnosis of Prostate Cancer.

Background Prostate cancer is a common malignancy among men, and health systems are adopting faster diagnostic pathways to improve outcomes. Traditional transrectal ultrasound-guided (TRUS) biopsies under sedation carry a notable risk of infection, prompting a shift toward transperineal (TP) prostate biopsy under local anesthesia (LATP) in outpatient settings. We aimed to evaluate a new clinic-based LATP pathway for prostate cancer diagnosis in terms of speed, safety, and patient experience. Methods We retrospectively reviewed all patients referred with suspected prostate cancer who underwent the outpatient LATP pathway at a London NHS trust over a six-month period (May to November 2024). The pathway included an initial one-stop clinic visit (assessment and prostate-specific antigen test), rapid multiparametric MRI, and an office-based TP prostate biopsy under local anesthesia. Data were collected from electronic records and a post-biopsy patient survey. Key outcomes included diagnostic timelines (from urgent referral to biopsy to definitive diagnosis), compliance with the 28-day Faster Diagnosis Standard (FDS), procedure-related complications within 30 days, and patient-reported measures (pain, tolerability, satisfaction, and anesthesia preference). Results A total of 115 men (mean age ~68 years) were included. The mean interval from urgent referral to biopsy was ~10 days, and from biopsy to confirmed diagnosis ~5 days, resulting in an average referral-to-diagnosis time of about 14.5 days. Overall, 85.4% of patients received a definitive diagnosis within 28 days of referral, exceeding the national FDS target of 77%. Only 14.6% exceeded 28 days, typically by just a few days due to minor delays. Prostate cancer was diagnosed in 65% of patients, of whom 76% had clinically significant disease (Grade Group ≥2). Complications were infrequent and minor. There were 2 cases of urosepsis (1.7%), both managed successfully with brief hospitalization, and 2 vasovagal episodes (1.7%) with no lasting effects. No patients experienced urinary retention, significant bleeding, or other serious adverse events (overall complication rate ~3.5%). Patient feedback was positive: the average pain score during biopsy was 6.2/10 (moderate discomfort), but tolerability was rated favorably (mean 3.2/10 on a 0-10 difficulty scale). The mean satisfaction score with the diagnostic process was 8.2/10. Among surveyed patients, 68% indicated they would choose the same local anesthetic biopsy again, 20% were unsure, and 12% would prefer sedation or general anesthesia if another biopsy were needed. Patients valued avoiding a hospital stay and receiving results quickly. Conclusions Implementation of an outpatient LATP biopsy pathway substantially accelerated prostate cancer diagnosis, with most patients receiving a diagnosis within two weeks of referral and more than 85% within 28 days. This fast-track performance exceeded national standards without compromising cancer detection rates (~65% overall) or patient safety. The complication rate was very low, confirming the safety of the TP approach. Patient-reported outcomes indicate that although the procedure can cause discomfort, it was generally well tolerated given the advantages of avoiding general anesthesia and hospitalization. Our single-center experience supports broader use of clinic-based LATP pathways to speed diagnosis and improve patient convenience, with general anesthesia reserved for the minority who need it.