Which Type of Biopsy?

Just my opinion but I would do the TP biopsy. It's more accurate and less chance of infection from what I've read.

Did your MRI show any suspicious areas or lesions to target? If so I've read the MRI guided Transperineal approach can target more of the prostate and specific lesions. My PSA numbers are similar but my MRI showed no focal lesions, an enlarged prostate, characteristics of BpH and Prostatitis so I'm just tracking them metrics at the moment.

I do not know much, but this is what my surgeon/urologist told me a few weeks ago. He has been the Urology Chairman at a large cancer center for the past 15 years. Lots of experience, concentrating on prostate cancer.

We decided I needed another biopsy (try to determine if Pirads5 lesion is 3+3 or has higher grade not sampled on 1st biopsy).

He told me he would do a transperineal biopsy, if I insisted. However, he said it is more difficult for him to do the transperineal and more diffucult to get good samples. He drew some sketches (which I did not understand due to my lack of intimate knowledge about prostate anatomy), showing how the biopsy needle could not reach certain areas.

I told him, If he felt a transrectal biopsy was the best for my situation, I agreed with doing the transrectal biopsy. In April, that is what I will have.

I know most indicate transperineal is better. My surgeon felt the transrectal was a better.

I will have an MRI before the biopsy and biopsy will be MRI guided.

However, Doctor said even with MRI guided, it is difficult to biopsy targeted areas. The images are overlaid during the biopsy, but not easy to always hit the lesion.

I do not have a recommendation for you. For me, I want the Doctor to perform the biopsy the way he feels best, to obtain the best samples.

Best Wishes

While the issue of infection does make the transrectal biopsy less desirable, the other benefit of TP Biopsy is that they can access more of your prostate when they do the biopsy. That can be really important when the Cancer is in spots they cannot access through a transrectal biopsy.

@charlesprestridge I have a TR biopsy scheduled for this coming Monday, the 9th because my PSA jumped from 3 to 4 within a year & the MRI showed a Pi-Rads 3 lesion. I start a round of Bactrim to ward off an infection the day before. I'll post back on how it went.

I've had two Transrectal Biopsies one that collected 12 cores and one that collected 24. From the various discussion on this forum, they both have their advantages and disadvantages.

The only thing I will ad is this. After my RARP I had 8 sessions of PT for Pelvic floor training to stop dribbling. The PT that did my intake asked me what type Biopsies I had. They shared that from a PT perspective it's easier to do PT and the exercises on someone that's had a Transrectal Biopsy. Transperineal biopsies cut into the pelvic floor muscles and then form scar tissue. Making PT a little more difficult. Just my experience.

A transperineal biopsy can also take a much larger sample, giving you a clearer picture of you cancer (if present). Something like 30-40% of transrectal biopsies get up or downgraded in post-RARP pathologies. Had I known what I know now, I would have looked for a transperineal biopsy.

I had a transrectal and had no problems but some blood in my semen. If I had to do it over again, I would choose a fusion biopsy for better imaging during the process and I might go for the trans perineal because of the bacteria from a TR potentially ending up as sepsis. Having said that, you are at a center of excellence so you have that experiential skill set available. You might want to ask the doctor about the multiple antibiotic regimen they use when they do a TR as well as any enhancements in the rectal cleaning process to avoid sepsis. If the answer is yes, they have a "special" antibiotic regimen, did it reduce their numbers of infections after they implemented it? Lastly, are you comfortable with the assigned doctor in terms of his reasoning for a TP over a TR? Is it a personal preference on his part or an institutional "bias"?

@ezupcic No lessons in MRI. It was totally clean.

@charlesprestridge Oh boy, this guy has had 15 yrs to hone his own special brand of Bullsh**!
The Transperineal is better in every conceivable way, except for those who don’t know how to do it.
Would LUV to see that picture he drew!🤣