Transperineal vs Transrectal biopsy

I had both transrectal (4 years ago) and trans perineal (this week). Mayo Rochester only does trans perineal, so I did not have a choice to make. Neither was that big of a deal for me. The trans perineal was done with local anesthetic only, surely was scarier and a bit more unpleasant (I have a low tolerance for pain and would not call it painful, just unpleasant). The worst part is waiting for results. Well, I also made the mistake of looking back at the aftermath once I stood up...do not do that! Reminded me on the prom scene from the movie Carrie. 🙂

I saw my urologist yesterday to go over my recent repeated PSA labs and the MRI from late July. He recommended the biopsy, which I agreed to believing we all need the information to be gleaned from the procedure. It will be the MRI fusion/guided intrarectal biopsy on 9/9. I truthfully trust and respect my urologist quite a bit, so I am sticking to the plan, comfortably. I am especially glad that we got it scheduled as soon as we did. I tried to advocate for bypassing the biopsy and getting the RARP done asap. He was funny about that idea -- and said no urologist would do the surgery without the pathology report. So.....

Try to get transperineal if you can. They not only have lower infections risk, but are also more accurate since rhey can take larger samples (i.e. more cores). I had a transrectal one since I could not find a transperineal in south FL.

It’s not as much that they can take larger samples. It’s that they can access parts of the prostate that cannot be accessed from transrectal biopsies. So you can have a more thorough biopsy.

Mine was transrectal and combined with a bladder scan during the same visit. I was awake the entire time. My urologist doesn't yet do perineal. I had no issue with infection. This was a "blind" biopsy which gave positive results and was followed by PSMA PET scan for a more thorough evaluation and appropriate treatment.

I have had six prostate biopsies in the last decade. I joke with my urologists that I should be inducted into the Guiness book of records :). Of these six, one was radndom needle biopsy, all the rest were MRI-guided. The first 5 were transrectal (one under sedation at UCLA), and the rest without sedation at Kaiser and an independent urlologist. I did not have any infection or complication with any of these 5 trasrectal biopsies. The most recent biopsy done at Keck USC was transpirenial under sedation. Given the location of the suspicious lesions, the urologist decided tranperinial biopsy was the most suited, and that is what I got.

But I did get serious infection earlier this year at a local urologist who conducted a urodynamic study of my bladder, which included inserting probes both through the urethra and rectum. It was not fun at all and worse it required three courses of antit-biotics to clear the ensuing infection.

Well my educated guess is that trans perineal is less likely to create an infection. Trans rectal requires antibiotics prior to the procedure and bowel prep to “clean” the area.

If doing a trans-perineal procedure then I would also find out if they are doing a MRI/US fusion method to visualize the area during the biopsies. I have read this is the best way to get the biopsies. Hope that helps

I had the transperineal biopsy done with MAC. I told my urologist that I don’t want local . This is when they found out that I have prostate cancer. Had the Aquablation done on June 24 and another biopsy in 6 months. It was only one day and I worked the next day. But I would suggest that you be off one day after the biopsy. All in all it was not
painful at all. Good luck.

I've had both transrectal and transperineal biopsies. The transrectal was performed by a well known urologist at Duke which surprised me that he still does them. It really wasn't that bad other than the ultrasound transducer shoved up there for fifteen minutes. The transperineal was done at UNC after I switched doctors. There was only local anesthesia used. However in my case, the doctor uses the maximum amount of lidocaine and told me afterwards that if I ever needed another biopsy, to request general anesthesia because I was so sensitive (not necessary as my prostate is long gone now). I would say the later had a longer physical recovery but understand it can get to regions the transrectal can't. Both rely on fusing the 3D MRI images with the live ultrasound images. I watched the entire process on the monitor during the transperineal and it was amazing to watch them sample from the target lesion.

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.