After a Gleason 3 = 4 lesion was revealed on an MRI and my urologist scheduled a transperineal biopsy with only local anesthesia and nitrous oxide but no general anesthesia, I worried and fretted for weeks. Even considered having the biopsy performed by a different urologist who offered general anesthesia. So glad that I did not as the worry and fretting were much worse than the procedure with the pain being less than having a cavity filled. From what I've learned, the level of pain depends in large part upon the level of experience of the doctor performing the procedure and his/her ability to sufficiently numb the the affected areas.