If you are like me, the thought of serious infection or sepsis is a very scary prospect if you must have a prostate biopsy. Prostate cancer is bad enough, but it usually isn’t an immediate threat and is often treatable. Sepsis is a very real and very urgent life-threatening risk. In the case of resistant bacteria, treatments may not be guaranteed.
Here is a nice guide to compare trans-rectal (TRUS) to trans-perineal biopsies (TPB):
There is apparently less risk of infection for this type of biopsy that goes in through the skin under the anus, rather than from inside the rectum. It may also allow for better sampling of some areas of the anterior prostate, such that it’s the preferred method when extra cores saturating more of the prostate are needed. The main drawback seems to be that it is usually done under general anesthesia, which isn’t necessarily a bad thing in my experience. This does usually mean at least one night in the hospital in many cases. I have survived two trans-rectal biopsies without infection, but consider myself lucky. I will seriously consider a TPB in the future if the option is available.