@drcopp
Glad to give you my experience with this. My transperineally biopsies were done with anesthesia. I think anesthetist use different type of anesthesia depending on the surgery. However I was not awake so what ever they used I has no conscious awareness of the procedure prior to, during, after and when awoke had to be told over.

I do know I had I.V. and anesthetist was there talking to me prior to going asleep. He was assuring me he was there if anything came up. I am a heart failure patient with ICD/Pacemaker. I just had this anesthesiologist week prior at a colonoscopy.

I had zero post operative pain. Would not even known if had the biopsies if they did not assure me it was over. Nothing of discomfort, or irritation after, even days after.

My urologist did want to do transrectal because I had heart failure. However I had anesthesia many times prior to biopsies with procedures colonoscopy. I got my heart failure doctor involved. HR doctor advised urologist there was no contradiction with me having anesthesia. Thus urologist then changed to transperineally using MRI/Fusion.

I did not want transrectal. I did not want to be awake with knowing up in colon and feeling the procedure. I also did not want the increase risk of infection. My Mayo Jacksonville urologist said that increase risk was 2% increase. I have read others being told they were told or read 1-2%. I go by and post what my medical doctors tell me directly and what Mayo Jacksonville uses as statistics.