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Are you sure , it is transperineal biopsy they are planning '?
Transperineal biopsy is the second choice technique in most of the patients unless the patient has severe rectal or anal condition.
Your PSA and the MRI finding is a strong indicator for prostate biopsy and you should opt for it.But a trans rectal biopsy would be enough under local anesthesia in your case.
Some studies have been done and has found marginal improvement in cancer detection rates with Trans -perineal biopsy technique.But it still remains the second choice for all the urologists due to the discomfort and only marginal improvement over trans-rectal biopsy.
Please let me know if you have any questions.
Thanks you. Transperineal biopsy is increasingly used in the UK - less risk of infection and more of the gland can be sampled especially anterior zones.
Do you have patients with bad experiences of recovering from transperineal? Retained urine? Bruising? (Temporary) nerve damage affecting potency?
What about reports of spreading cancer cells through 'needle tracking' -a real risk or myth?
What do you think about repeating the PSA to see if it has reduced and seeing what PCA3 says about cancer risk? If PSA reduced and PCA3 says lower risk I'm tempted to put off the biopsy altogether and have another MRI-S in say 3 months - obviously a risk if there is an aggressive cancer there.....