I don't think that transperineal is the standard in the USA, yet. I was not offered it in Tucson - a fairly large and progressive city. In fact, researching Mayo Arizona, I found that they claim to be one of the few centers (of excellence!) in Arizona that offers the transperineal biopsy. I am scheduled for transrectal biopsy next week - MRI fusion-guided - because that is what my urologist offers. I will see a Mayo Clinic doctor for consultation and consideration of unique focal treatment in late October, which is the first appointment available. The Mayo doctor said to keep my appointment and get the biopsy done now, then send pathology report to him. I was "freaking out" about this topic until I saw a great, detailed presentation by urologist, Dr. Michael Ahdoot on YouTube. His presentation helped me understand and relax. You should see it!!! https://youtu.be/bK1ozkOgatw?si=Hy1DrRFDWweg8rIz