Standards for Prostate Biopsy
The Transrectal Approach
The transrectal approach is favoured amongst doctors for its convenience, short learning curve and low cost. A systematic freehand transrectal biopsy (Fig 1.) may be performed in-office in as little as 10 minutes. Because the procedure is often done under local anaesthesia, this eliminates the need for specialized staff, a dedicated operating room and specialized equipment.1 Transrectal biopsies are considered a “dirty” procedure because the needle passes through the rectal wall, where each pass poses a risk to inoculate the prostate with rectal bacteria. To prevent infection, an enema and prophylactics, typically fluoroquinolonesFluoroquinolones are a type of carbapenem which is a highly effective class of antibiotics typically used to treat resistant bacterial strains.4, are administered prior to biopsy.1 However, fluoroquinolones have a major drawback in that its routine use may be developing the growth of antibiotic resistant bacteria and therefore making prophylactics less effective.1 Advances in MRI-targeted biopsy have addressed the issue of inaccuracy and a high false negative rate, but there is still concern for potential complications like rectal bleeding, fever, sepsis, hematuria and acute urinary retention.3
The Transperineal Approach
“The rate of sepsis post-transperineal biopsy is nearly 0%, which is 40 to 70 times less than that of transrectal.”5
The Fusion Bx: A Transrectal and Transperineal Solution

1 Grummet, J., Pepdjonovic, L., Huang, S., Anderson, E., & Hadaschik, B. (2017). Transperineal vs. transrectal biopsy in MRI targeting. Translational Andrology and Urology, 6(3), 368–375. doi: 10.21037/tau.2017.03.58
2 Kasivisvanathan, V., Rannikko, A. S., Borghi, M., Panebianco, V., Mynderse, L. A., Vaarala, M. H., . . . Moore, C. M. (2018). MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. New England Journal of Medicine, 378(19), 1767-1777. doi:10.1056/nejmoa1801993
3 Xiang, J., Yan, H., Li, J., Wang, X., Chen, H., & Zheng, X. (2019). Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: a systematic review and meta-analysis. World Journal of Surgical Oncology, 17(1). doi: 10.1186/s12957-019-1573-0
4 Zowawi, H. M., Harris, P. N. A., Roberts, M. J., Tambyah, P. A., Schembri, M. A., Pezzani, M. D., … Paterson, D. L. (2015). The emerging threat of multidrug-resistant Gram-negative bacteria in urology. Nature Reviews Urology, 12(10), 570–584. doi: 10.1038/nrurol.2015.199
5 Grummet, J. P., Weerakoon, M., Huang, S., Lawrentschuk, N., Frydenberg, M., Moon, D. A., … Murphy, D. (2014). Sepsis and ‘superbugs’: should we favour the transperineal over the transrectal approach for prostate biopsy?. BJU International, 114(3). doi: 10.1111/bju.12536
6 Patel, P. (2020, February). The case for transperineal prostate biopsy vs. the transrectal approach. Urology Times, 48(2), 16–17.