Need to Make Decision between Trans-rectal or Transperineal Biopsy

I've had both.
Transperineal was much better in my experience!

As others have mentioned, transperineal is preferred over transrectal these days.
That said, during the 9 years that I was on active surveillance (2012-2021), I had 4 transrectal biopsies with no complications. Each was with local anesthetic and antibiotic protocol prior to the procedures.
For my first transrectal biopsy, I drove myself there and back home. For my first experience it was quite unnerving, but not terrible or traumatic.
For my fourth (& final) transrectal biopsy before receiving active treatment, I invited my wife to be in the room where the MRI-guided procedure was being done. I wanted her to see that it wasn’t as painful as she was imagining. She said ok; the urologist said ok. So she sat in the corner of the room (towards my head) during the entire procedure.

The choice of procedure is a personal call; good luck with your decision.

@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.

Be aware that the Transperineal biopsy allows doctors to reach parts of the prostate that a trans-rectal biopsy can not reach.

If you have metastasis in the prostate that are in those hard to reach areas you’re much better off with a transperinial biopsy.

I had both done and my nervousness wasn't really necessary. Locally I was only offered the transrectal procedure done in the Urologists Office. I stayed on active surveillance because the samples taken showed a (3+4=7) and a couple of (3+3=6). Months later I went to Mayo and they did an MRI guided Transperineal Biopsy, taking 19 cores that they were specifically aiming at targets, based on what the MRI showed them, at least as I understood it. That showed that I had several (4+3=7) areas that weren't detected on the previous biopsies, as well as other info. That motivated me to move from surveillance to treatment, also because I found out that I had 3 family members with a prostate cancer history. For the Transperineal procedure they put me under so I felt nothing other than some slight soreness in the area for a few days, and they advised me not to ride a bike, motorcycle, or horse for a while. Not an issue for me.

Transperineal was definitely better for my husband. He had multiple transrectal biopsies before… even with high Pirads lesions the transrectal biopsies found either nothing or a tiny amount of Gleason 6.

In 2023 he had his first transperineal biopsy … 8 cores were found with cancer …Gleason 9 and Gleason 7s

He did have to wait for the biopsy.. about 2 months. Mayo had just hired a doctor who could do transperineal biopsies and there was a waiting list

Not too many urologists perform transperineal biopsies. I had one mainly because I seem to have a propensity to develop infections. I recommend transperineal.

I had a transperineal with a local anesthetic only. I was awake and alert. The urologist said it would be like a trip to the dentist. (Well not really) I drove myself home (a 45 minute drive) afterwards. Not what I would do for fun but not too bad either. There was a point when I was looking at the needle about to be used, and the nurse said don't look!. I said, "I'm not able to un-see it !!!

Transperineal has 2 punctures in the skin and takes 12 snips of the Prostate for cancer evaluation. It uses an overlay of the MRI and the acoustic probe in the Rectum and X- ray for positioning
Transrectal has 12 punctures through the rectum the same sort of probe and X-ray to view the needles in the Prostate.. This is a much older method and can be done in the Urologist's office
Most of Europe does not use this method. Punching holes through the Rectum can lead to infection and sepsis. I researched this extensively and although both are pretty safe, the Transperineal has less than 1/2 the serious sepsis risk. Shoving 12 things from the poop side is not a good plan and only done because it is low tech and cheaper

I too I transperenial 4.5 years ago. Just had a numbing shot and also injecting the SpaceOar. No pain at all. Not pain tolerant so I worried about pain, but there was none.