@indyguy I’ve had about 15 biopsies over the last 25 years. Two or three of them were completely negative, the remainder were all 3+3 except the one most recently in 2025 was 3+4 according to one institution and 3+3 according to the second opinion. Until recently all the biopsies were transrectal until transperineal came into vogue. I was lucky in that I never had significant trouble with any biopsy but my preference would be transperineal due to suspected less risk of infection. At age 77 I am willing to continue with active surveillance and take the risk of metastasis in the next 10 to 15 years if I live that long. It’s just educated guesswork about the risks of treatment versus the risk of metastasis and the inevitable fact of death from some cause at my age. Finally since you are facing a first biopsy I would say the first few can be nerve racking but after that they just become routine and no big deal. There is a lot of great information on YouTube videos about all kinds of prostate cancer issues but it takes a lot of time and research to delve into the numerous issues involved.