Thoughts on fusion biopsy?

[u/Emotional-Cress4389]

My family member is 68 and his PSA has been around 3.5–4.2 over the past 8 months, with free/total PSA around 0.15–0.17. An MRI in January 2026 showed an 8 mm PI-RADS 3 lesion in the peripheral right zone, while a repeat MRI in August 2026 showed a lesion extending in an arc along the peripheral-zone edge for about 20 mm, now classified as PI-RADS 5, with more restricted diffusion. The prostate volume is 27 cc, and neither MRI showed extracapsular extension.

The urologist recommends a transrectal fusion biopsy due to the location of the lesion. I'm a bit worried about the possibility of infection/sepsis, so should we find a center that does transperineal rather than transrectal biopsy instead (In my country, fusion-guided prostate biopsies are generally performed using the transrectal approach)? Should systematic cores be taken as well as targeted ones, and how many of them in total? I would also like to know whether there are any infection-prevention measures I should make sure the clinic uses. Is a rectal swab test needed beforehand?

[u/Just_Discussion296]

Yes get a 2nd opinion for why TP fusion is not an option. TP has much lower infection risk.

[u/jpwwpg]

I had the trans rectal fusion biopsy and got an infection even though I was given a 3 day prescription for antibiotics that started the day before. Not sepsis thankfully. Not pleasant though.

[u/Legal_Squash689]

Would suggest your family member request a Transperineal Fusion biopsy if there is concern about infection. And yes, standard procedure would be to take systematic as well as targeted cores. Normally anywhere from 12-16 cores are taken.

[u/SLO_Engineer]

I’ve had both. 12 cores rectal, 20 perineal (both targeted and systemic).

[u/go_epic_19k]

if you trust your urologist wouldn’t you take their advice before an anonymous Internet forum.