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@dribbles
You are going to get a lot of post about antibiotics. What one person gets or does should not suggest what you should do. Only your doctors have your complete medical and mental health history.
I don't see any post from those that did come down with infection from a transrectal. If you read their stories they definitely would not have transrectal again. Several past posters had serious time and recovery. I am not sure how many are out there got infections with transperineally. You can still get an infection if done transperineally but it is very low.
Urologist doing biopsies recommend antibiotics for a reason. The chance of infection is there and antibiotics are a preventive measure. For me doing something preventive is much more important that having to take massive antibiotics after a post procedure with an infection. But that is me and not trying to say do this or that.
My urologist (Mayo Jacksonville) gave me a 2% chance of infection if done transrectal. If done transperineally such a low number not given. However, with any surgery there is chance of infection and thus the antibiotics suggestion.
Most urologist and R/Os (doing markers and Space/Oar, biopsies) will do a smear to determine the specific type of antibiotic for you.
Your decision though. Talk to your medical doctors about your concerns.
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@jc76 As I’ve posted before, I had 4 transrectal biopsies while I was on active surveillance (2012-2021) and had no infection-related or recovery issues (beyond what was advised - blood in stool, urine, and semen for differing periods of time). There were no surprises.
I took antibiotics exactly as prescribed; did the enema exactly as directed. Also discussed with the urologist about using as much lidocaine (or whatever the numbing agent is called) as was allowed The biopsies were relatively uneventful.
(As has been pointed out, risk of infection is much less with the transperineal method for obvious reasons.)
For my first transrectal biopsy, I drove myself there and back home. Yes, for my first experience it was quite unnerving, but not terribly traumatic (with enough Lidocaine!). For my fourth (& final) transrectal biopsy before receiving active treatment, I invited my wife to be in the room where the MRI-guided transrectal procedure was being done. I wanted her to see that it wasn’t as painful as she was imagining. She said ok; the urologist said ok. So she sat in the corner of the room (towards my head) during the entire procedure.
(Surprisingly, in this 2015 paper, there were higher incidences of needle-tract seeding identified with transperineal prostate biopsies than with transrectal: https://pubmed.ncbi.nlm.nih.gov/24958224/)