(UroToday.com) For the past three decades or more, transrectal ultrasound (TRUS) guided biopsy has been considered the standard diagnostic approach for the detection of prostate cancer. In the past few years, driven in large part by concerns regarding post-biopsy sepsis in patients undergoing TRUS procedures, transperineal biopsy has been increasingly utilized with equivalent cancer detection rate compared to TRUS biopsy. Concurrently, there has been an increasingly large role of pre-biopsy magnetic resonance imaging (MRI) with targeted biopsy. However, data on the detection rate, the tolerability, and the complications of mpMRI targeted fusion transperineal biopsy (TPFBx) under local anesthesia (LA) are limited and thus the relative merits of transperineal and transrectal routes for prostate biopsy are still debated. To better inform this discussion, in a moderated poster presentation at the American Urologic Association (2020) Virtual Annual Meeting, Giancarlo Marra, MD, and colleagues presented results of their study assessing mpMRI targeted fusion transperineal biopsy under local anesthesia.