Objective
There is growing interest in transperineal biopsy as an alternative to TRUS biopsy for patients undergoing repeat prostate biopsy. We sought to determine the rate of hospital re--‐admission for sepsis following transperineal prostate biopsy using both local data and worldwide literature.

Methods
Pooled databases on transperineal biopsy from multiple centres in Melbourne were queried for rates of re--‐admission for sepsis. A literature review of Pubmed and Medline was also conducted using the search terms “prostate biopsy, fever, infection, sepsis, and septicaemia”.

Results
A total of 245 transperineal biopsies were performed (111 at the Alfred Hospital, 78 at Epworth Richmond, 38 at Peter MacCallum Cancer Institute, 14 at Epworth Freemasons and 4 at other institutions. The rate of hospital re--‐admission for infection was zero. The literature review showed that the rate of sepsis following transrectal ultrasound—guided (TRUS) biopsy appears to be rising with increasing rates of multi--‐resistant bacteria found in rectal flora, and is as high as 5%. Various techniques attempting to combat this were reported with variable success. The rate of sepsis from reported series of transperineal biopsy, however, approached zero.

Conclusions
Local and international data suggest a negligible rate of sepsis with transperineal biopsy. This compares to a concerning rise in the rate of sepsis following TRUS biopsy due to the increasing prevalence of multi--‐resistant bacteria in rectal flora. TRUS biopsy is convenient, cheap and quick to perform. However, as clinicians we have an obligation to minimize harm to our patients. We believe that transperineal biopsy should therefore be offered as an option, not only to patients undergoing repeat prostate biopsy, but to all patients in whom a prostate biopsy is indicated.