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