Transperineal vs Transrectal biopsy

From what I've read, transrectal isn't common these days, due to the possibility of infection.

Transperineal seems to be the standard.
That's what I had, anyway.

But that doesn't get us out of the horrible rectal invasion.
I can only speak to the experience that I had.
Although the actual biopsy needle goes in through the perineum, my urologist also slid in an ultrasound probe in the rectum. (totally the not-fun experience it sounds like)

The idea is that they have the MRI scan available & use that as a guide, using a grid system.
The ultrasound enables them to pinpoint exactly where the needle is going.
So they basically play Battleship with your prostate.

It's not all bad, though.
This is just a day at the office for them & my urologist kept me distracted with a long chat about arcade games.
It totally worked.

Transrectal has a higher chance of infection than transperineal. While, I had three transrectal biopsies and never had a problem. Some people in this forum and other places have reported having to spend a week in the hospital after having an infection from the transrectal. The infections are not always that severe, but it can happen.

It is real hard for me to believe that UCSF doesn’t do transperineal.

@mauk
I was first told my biopsies would be done transrectal because I have heart failure. Transperineal is done through the perineam and usually done with anesthesia. Transrectal is done through the rectum.

Transrectal carries a 1-2% increase in a serious infection. My urologist stated I would have to spend 2-3 days in hospital if I got it. I insisted on transperineal. I got my heart failure doctor involved and he informed urologist that I had no issue with having anesthesia and thus had it done transperenial.

I had the biopsie called MRI/Fusion. It used the information from my MRI. I was asleep so felt nothing prior, during or after. We are all different in both our physical and mental outlooks. I did not want to have even the 1-2 percent increase in a serious infection. I also did not want to be awake. I also wanted the procedure the most updated and thorough it could be.

So from my experience on this I insisted on transperinal and have listed above why I chose that. And the urologist who wanted to do transrectal was at Mayo.

I had transrectal and, at the time, I had no idea that there was a choice. I had zero issues, one big antibiotic pill beforehand and it was done.

I traveled to Mayo in Rochester and had transperineal done because my local center was only doing transrectal. Procedure done by a Nurse Practitioner with just some local. It was quick and easy. Highly recommend.

Same here...big pill and fleet a couple hours before procedure. Zero issue with infection, however, the "It's not going to hurt, you'll just feel pressure" was pure crap. Two of the samples sent me to the ceiling and it felt like someone kicked me in the groin for a couple days after. I am certainly not looking forward to another one.

I believe the US fusion over lay of previous MRI images can also be done TRUSS. (transrectal ultrasound...). Nonetheless an English Professor of Urology commented that transrectal biopsies are substandard care in the UK. The transperineum biopsy also can well visualize the anterior prostate whereas the TRUSS technique does not. Although less common cancer there they may be more of concern. I had a transpereum bx but I was not forewarned that there would be general anesthesia. If local anesthesia was an option I certainly would have chosen it. The commercial insurer was billed 35K!!, 7K considered, 5K paid, and I still had a $1,500 bill for co/deductibles. The quality slippery slope up helps the industry too.

Incidentally while on the matter of slopes:
Interstitial radiotherapy [('ISR' f/k/a seeds] : 'SBRT : IMRT : : X$ : 5$ : 7$) One salaried big wig said traffic to and from the seed place was a reason for de-selecting it in favor of equi-effective SBRT. I thought 20% more radiation in seeds in a one and done might appeal more to customers. Asked about 'ISR' he replied "Huh' Find one." (not it won't be just as good.)

I recently had a repeat biopsy and requested transperineal and was told that it was a newer procedure and he hadn’t been trained. Either way, ask for anesthesia. My tranrectal was in my opinion barbaric. Too many specimens and prolonged time to complete. I was not happy.

I had two Transrectal Biopsies and was given massive amounts of Antibiotics each time. I don't know if this is true or not but after my RARP I did 8 seasons of Pelvic floor training PT. At the Initial PT session they did a number of measurements and then they did an assessment of the muscles necessary to Properly perform a Kegel. They asked me if I had Transrectal or Transperineal biopsies and I told them Transrectal. The PT told me that Transrectal biopsies were "better" from a PT perspective because it does not damage those muscles and doing Kegels and Post OP Pelvic Floor Training had better outcomes.

My understanding is that most urologists are continuing to do transrectal biopsies. Transperineal biopsies are relatively new and were believed to result in lower infection rates. Turns out this apparently is not true. Both biopsy approaches have similar very low post procedural infection rates. I've also heard the transperineal biopsies are more uncomfortable/painful for the patient than the transrectal.

I inquired with my university center of excellence urology team and they shared this info with me and said they don't even do transperineal biopsies...just transrectal. Mine was transrectal and I was fine but I did insist on being fully knocked out (general anesthesia). No post procedure infection or pain