It’s not so much a matter of where the biopsy is done as how it is done.

You want to get a Transperineal biopsy not a transrectal biopsy. The reason is the rectal biopsy has a much higher chance of infection. It also cannot reach all parts of the prostate.

Yes, you want to get the fusion biopsy because they use the MRI that shows the PIRADS 4 Tumor and allows him to directly get samples from it. It’s a much more accurate biopsy.