I had a transrectal biopsy about 12 years ago and they missed the cancer. After the biopsy my PSA’s continue to rise so the doc decided to do a tranperineal biopsy under anesthesia. They found it then but unfortunately too late. It had already metastasized. My advice: if you want to be sure that the biopsy tells you what do you need to know ask for a transperineal biopsy!