This topic is about exploring options for a prostate biopsy for someone who has had their colon and rectum removed due to colitis and now lives with an ileostomy. With an elevated PSA and a lesion found on an MRI, a prostate biopsy is necessary. Since the rectum is no longer present, the usual transrectal biopsy isn't possible, and the urologist suggests a perineal needle approach instead. The person is seeking advice from others who might have experienced this type of biopsy.

Here are some helpful insights and advice:

1. Perineal (trans-perineal) needle biopsies have been done for others in similar situations. While they might cause temporary discomfort, the recovery is usually quick and without complications.

2. Other alternative biopsy routes have been reported:
- Trans-urethral biopsy, which is done through the urethra.
- Biopsy through the residual pelvic opening left after the rectum has been removed.

3. It might be beneficial to seek a second opinion to determine which biopsy method is best suited to your specific anatomy and the experience of the surgeon.