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Introduction: MRI-targeted prostate biopsy is the best diagnostic tool for clinically significant Prostate Cancer (PCa) detection. However, compared to the cognitive approach, the superiority of the approach with US/MRI fusion software for the detection rate is still unanswered. The study aim to assess possible differences in the detection rate of transperineal Freehand US/MRI fusion target prostate biopsy using the Esaote MyLabTM9 System® in two different settings: outpatient setting with local anesthesia and patients undergoing deep sedation. Case Study: A retrospective monocentric study was carried out at “San Pio” Hospital of Castellaneta, Italy, including 81 patients undergoing transperineal prostate biopsy from January 2021 to June 2022. The fusion biopsy was performed under local anesthesia or under deep sedation. All the enrolled patients performed a multiparametric prostate MRI before undergoing a prostate biopsy. All the Freehand US/MRI fusion target prostate biopsies were performed using the Esaote MyLabTM9 System®, standard sampling, and targeted sampling. We evaluated the detection rate differences between the local anesthesia approach and that under deep sedation. Results: There are no statistically significant differences between the two approaches to PI-RADS 4 (p>0,05; p=0,63) and Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions. Conclusion: These data highlight the lack of potential detection rate benefits of the deep sedation approach over the procedure under local anesthesia.