@oceanmd
Once a biopsy is taken there is not much difference in what is better. They both go to pathology for prognosis.

Now which one is best for you. That depends on what your pain level is. Your anxiety level. Stress level. One is done usually under anesthesia (tranpernial) and you feel nothing. The other is done while you ar are awake. So that is first a decision for you to make is what level of discomfort or anxiety to you feel comfortable with.

With transrectal you increase your infection rate to 1-2%. Sounds low but see posters on MCC who did get infected and what they had to go through to cure the infection.

I chose transperenial. My urologist wanted to do transrectal. I think because is easier procedure for them and done in an special office setting where transperinal is done in operating room with anesthesialogist.

I did my markers and SpaceOar done transperineal but not under anesthesia. It was not something I enjoyed and I used laughing gas to calm me. I would rather had it also done with anesthesia but at UFHPTI it is done without it but transperineai.

So some of us can handle a biopsy done transrectal and some of don't want to subject ourselves to that type of biopsy procedure. I can pass on my experience with transrectal biopsies done with MRI/Fusion. There was nothing prior (sedative), not awake during procedure, no pain or discomfort after procedure.

Good luck but research both look at pros and cons and decide what you want to subject your body to based on you not someone else.