Need to Make Decision between Trans-rectal or Transperineal Biopsy

Transperineal is orders of magnitude better than transrectal in terms of infection risk, and you don't have to take preventative antibiotics. Perhaps that's why there's a longer waiting list.

I second @northoftheborder you want a transperinial, safest way. We have had a few reports in here from people that have had infections that were very serious after a transrectal biopsy

I "third" it ! Unless you have to wait 6 mos for transperineal ... : (. But still, can you find different place to do it, place that can take you in sooner ?

I had transrectal biopsy last September. I had read about the risk of infection, etc. but my doc had a good track record, so I went ahead. It was really not bad, a little pain when they first numb the prostate was about the only downside. They gave me a Valium tablet about an hour before, kept me very relaxed. Went out for lunch with my wife after the procedure, and had a great day. A little blood in the urine for a few days.

I also had transrectal, zero issues outside of the normal small amount of blood. They give you a super antibiotic, one of the kind that you can only take once or twice in your life. My first one was canceled when I showed up, they had to prescribe a totally different one for my second attempt. Honestly I was never given the option, but if I was I still would go with rectal over perineal.

My guess is that you'll find an even mix on here so do what you feel is best for your situation and comfort level.

I've had two Transrectal biopsies and the antibiotics they gave me for the first made me extremely ill. I had to go to my PCP to get medicine to control the upset stomach etc. I didn't get an infection the antibiotics killed my microbiome. The second biopsy wasn't as bad. I wasn't in too much pain for either one. For both of mine the urologist wanted to do transrectal. I was never sedated for either of mine or give pain meds for after care. If you have never had a biopsy the amount of blood after the procedure can be shocking.

Some additional info :

Infection risk for TR 10-20%, for TP 1-2%
Ability to sample anterior prostate TR limited , TP full
Allows mapping TR no, TP yes

Howad Wolinksy has a great recent article on substack, which I think you can view without subscribing.
https://substack.com/home/post/p-160262926
If it isn't too long of a wait I'd go with transperineal, but if your anxiety is getting the better of you, then travel for a transperineal or do the transrectal.

My take away on the article is that the biggest advantage of transperineal is that it finds more clinically significant cancer, which is the reason for the biopsy. Your state of mind is also a large factor in your decision.

As a side note - the article says that Medicare covers general anesthesia if you think you will want that with the transperineal.

All the best to you in your decision making.

@oceanmd
You will get a lot of feedback on your question.

We are all different it our ability to handle stress, anxiety, pain, discomfort, and worry about increased infection rates of transrectal.

We should not tell you what to do just give your our experience. I chose and wanted transpernial. I did not want the increased chance of infection even if 1-2%. My urologist tried to have me do in transrectal as I think is much less involved that having it done transpernial. He said even if you got infected would only have to spend a couple of days in hospital. So I insisted on transpernial.

For me I did not want the increased infection rate. I did not want to be awake. I did not want to deal with stress and axniety being awake and having something done through my rectum versus being asleep and through the scrotum area.

It really depends on you and what is important to you and what your physical and mental outlook is toward how both procedures are done. I had no pain at all after procedure. Unless they told me it was over I would not even have known it was over. I had not post op pain at all.

Do some research on line to see how both are done and see what you think is what you would like specific for you and not what others would prefer as they are not you.

Transperineal……