There is a 1-2% increase in risk of infection having it done transrectal. That may seem small but those on MCC that had it done transrectal and got infection will tell you if had to do over would have insisted on transperineally. There is also another side of choosing which way you prefer and that is your physical and mental side of having it done transrectal.

My urologist wanted to do a transrectal due to having me having heart failure. I had had many procedures done requiring anesthesia with no problems. I informed my heart failure doctor of the issue, and he contacted urologist saying having anesthesia was not an issue for me.

I then had it done transperenial MRI/Fusion. I don't think my urologist liked me going around him, but I could care less as my body, my biopsies, and my preference to have it done transperineally. I had sedation prior to biopsies, no pain prior, out during procedure, and no pain after. Would not even know I had it if was not told when I woke up that it was over.

There is a second thing with this. The patient's mental outlook and stress tolerance. Some have no problem being awake and something put up your anus, and needles put in your prostate while you are awake and some find this very strssful. We are already under severe stress with the possibility of having prostate cancer and for me and many others we wanted it done the least stressful way it could be done.