Great to see a team effort on research! When my wife and I were researching biopsies, she found that TPUS (trans perineal) were less likely to cause infection. While the infection rate with TRUS (trans rectal) biopsies is fairly low, about 1 in 100, it drops 5x with TPUS.

I needed to change Urologists in order to get this procedure which also turned out to be a benefit as my new Dr. was highly accomplished and had led in the introduction of new technologies at Stanford Medical. I tolerated the TPUS biopsy well with local anesthesia. There is some minor pain as needles are injected, however, Drs. typically prescribe Ativan to chill you out and it helps with the 'chomping' that is apparent with all types of biopsies.

I had a minor complication that I had had before during a sigmoidoscopy. Vasovagal reaction is the vagal response when stimulation of the vagus nerve causes symptoms such as lightheadedness, sweating, and blurred vision. This can happen because of stress, pain, heat, having a bowel movement, or even standing too long. It passes quickly, but, my wife freaked when the color ran out of my face.

Best of luck!