Evaluation of the Learning Curve of Freehand Transperineal Prostate Biopsy Performed Under Local Anesthesia

Background: To evaluate the learning curve (LC) of office-based freehand transperineal prostate biopsy (f-TPBx) performed under local anesthesia and its correlation with the operator experience. Methods: A total of 176 patients who underwent f-TPBx between June and November 2023 were retrospectively analyzed. The first 44 cases of four different physicians (2 consultant urologists and 2 urology residents) were included, and patients were stratified into quartiles (Q1–Q4). The LC was assessed based on differences in procedure time, fibromuscular core rates, cancer detection rates, and complication rates across quartiles. A multivariate analysis was performed to identify factors affecting procedure time. LC of consultant urologists and urology residents was compared. Results: There was a significant reduction in procedure duration across quartiles (Q1: 22.3 ± 4.2 minutes versus Q4: 13.7 ± 4.1 minutes; P < .001), alongside an increase in clinical significant prostate cancer detection rates (P = .034). Fibromuscular core rates significantly decreased, and overall complication rates declined over time (both P = .001). It has been observed that the LC for consultant urologists was completed after approximately 20 cases. Cumulative SUM and locally weighted scatterplot smoothing analyses demonstrated that consultant urologists reached the plateau phase earlier. According to multivariate regression analysis, quartile variable were among the factors significantly affecting procedure time (P < .001). Conclusions: The LC for f-TPBx appears to plateau after approximately 20 cases, suggesting that stable procedural performance can be achieved within a relatively short period. The technique provides notable advantages, including high patient comfort, a strong safety profile, and rapid learnability, which support its successful integration into clinical practice. © 2026, The Author(s)