Patent Publication Number: US-2023149041-A1

Title: Transperineal prostate biopsy device, systems, and methods of use

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     The present application is a continuation of U.S. Application No. 16/991,150 filed Aug. 12, 2020, which application is a continuation of U.S. Application No. 14/874,104 filed Oct. 2, 2015, now U.S. Pat. No. 10,743,909, which application is a continuation-in-part (“CIP”) application of and claims priority to U.S. Pat. Application No. 14/677,286 (“the ‘286 application”), filed Apr. 2, 2015, now U.S. Pat. No. 10,064,681, titled “METHOD, SYSTEM, AND DEVICE FOR PLANNING AND PERFORMING GUIDED AND FREE-HANDED TRANSPERINEAL PROSTATE BIOPSIES.” The ‘286 application claims priority under 35 U.S.C. § 119 to U.S. Provisional Pat. Application No. 61/974,826, which was filed Apr. 3, 2014. 
     All of the above-referenced applications are hereby incorporated by reference in their entireties. 
    
    
     TECHNICAL FIELD 
     Aspects of the present disclosure relates to biopsy procedures and systems. In particular, the disclosure relates to methods, systems, and apparatus useful for planning and performing guided and free-handed transperineal prostate biopsies. 
     BACKGROUND 
     A biopsy is a medical procedure that involves sampling and removing tissues or cells from a living body for further examination and analysis. A prostate biopsy may be performed by a care provider for diagnosis and treatment of a patient’s prostate. For example, the vast majority of patients with an abnormal prostate specific antigen (PSA) or suspicious results from a digital rectal examination (DRE) undergo biopsy. Typical biopsy procedures include transrectal ultrasound-guided (TRUS) biopsies and transperineal ultrasound-guided (TPUS) biopsies. 
     TRUS involves obtaining tissue or cell specimens by passing a biopsy needle or other biopsy instruments through the rectal wall and into the prostate at various locations using a sagittal imaging plane. The biopsy needle or other biopsy instruments may be guided by ultrasound in a sagittal plane. There are disadvantages associated with TRUS. In particular, the patient may be required to take antibiotics prior to the procedure to reduce the risk of infections. Also, TRUS requires the patient to perform bowel preparation, which is a procedure usually undertaken before the biopsy, for cleansing the intestines of fecal matter and secretions. Further, the passage of the biopsy needle through the rectal wall may introduce bacteria from the rectum into the prostate, such as coliform bacteria that may lead to an infection or other complications. Additionally, many clinically significant prostate cancers are found in locations of the prostate that are often too difficult to access when using the transrectal approach. 
     TPUS includes obtaining tissue or cells specimens by passing one or more biopsy needles through the perineum and into the prostate. TRUS has been favored over TPUS. Unlike TRUS, TPUS does not require a patient to take antibiotics prior to the procedure or to undergo the bowel preparation for lowering the risk of bacterial issues. Further, TPUS uses a more effective route to access the prostate and is capable of accessing target locations that may be difficult to access utilizing the transrectal approach in comparison with TRUS. In addition, the needle does not pass through the rectal wall which eliminates the risk associated with TRUS of coliform bacteria entering the prostate or the bloodstream. 
     Systems configured for TPUS include a biopsy grid that may be fixed to, for example, a floor, platform, or table on which the patient receiving the biopsy lies. The biopsy grid may provide multiple apertures through which a biopsy needle or other biopsy instruments may be inserted. An ultrasound probe is fixed directly to the apparatus and is used to axially guide the biopsy needle or other instruments, for example other biopsy instruments. Thus, TPUS systems require imaging in an axial plane of the ultrasound or a transverse transducer for positioning the biopsy needle. 
     It is with these observations in mind, among others, that various aspects of the present disclosure were conceived and developed. 
     SUMMARY 
     Aspects of the present disclosure involve a biopsy guide configured to couple with a transrectal probe and for use in guiding an access needle in a transperineal prostate biopsy procedure. The access needle may be configured to perforate and be positioned within subcutaneous tissue of a perineum at an access site of a target area of a patient. The biopsy guide may include a guide member and a displacement member supported by the guide member. The guide member may be configured to operably couple with the transrectal probe and including a distal end, a proximal end opposite the distal end, and a length extending along a longitudinal axis between the distal and proximal ends. The displacement member may be configured to support the access needle and displace the access needle along at least a portion of the length of the guide member between the distal and proximal ends. The access needle may be configured to extend into the subcutaneous tissue when the access needle is displaced to the distal end. 
     In certain embodiments, the biopsy guide may further include the access needle. 
     In certain embodiments, the biopsy guide may further include the transrectal probe. 
     In certain embodiments, the displacement member may be configured to displace along the at least a portion of the length of the guide member between the distal and proximal ends. In certain embodiments, the guide member may include a guide rail extending at least a portion of the length between the distal and proximal ends, and the displacement member may include a coupling mechanism to releasably couple with the guide member. In certain embodiments, the displacement member may be configured to displace relative to the guide member via interaction of the coupling mechanism and the guide rail. 
     In certain embodiments, the displacement member may be configured to slidingly displace relative to the guide member via interaction of the coupling mechanism and the guide rail. 
     In certain embodiments, the guide rail may include a first guide rail and a second guide rail opposed to the first guide rail, the displacement member releasably coupled between the first and the second guide rails. 
     In certain embodiments, the coupling mechanism may include: first upper and lower members which may be configured to sandwich the first guide rail; and second upper and lower members which may be configured to sandwich the second guide rail. 
     In certain embodiments, the coupling mechanism may include upper and lower members which may be configured to sandwich the guide rail. 
     In certain embodiments, the displacement member may include a plurality of needle receiving ports for positioning the access needle in a plurality of orientations relative to the transrectal probe. In certain embodiments, each of the plurality of needle receiving ports may be configured to align the access needle parallel with a longitudinal axis of the transrectal probe. In certain embodiments, the plurality of needle receiving ports may include five needle receiving ports. 
     In certain embodiments, the biopsy guide may include a lower mount releasably coupled to the guide member and including a probe coupling mechanism for releasably coupling with the transrectal probe. 
     In certain embodiments, the probe coupling mechanism extends at least partially around the transrectal probe, wherein the guide rail extends distally beyond the probe coupling mechanism. 
     In certain embodiments, the probe coupling mechanism extends at least partially around the transrectal probe, wherein the displacement member may be configured to distally displace beyond the probe coupling mechanism. 
     In certain embodiments, the guide member may include a slot extending a first length between the distal and proximal ends, the displacement member including a rail member may be configured to be received within the slot such that the displacement member is displaceable along the at least a portion of the length of the guide member between the distal and proximal ends. In certain embodiments, a longitudinal axis of the slot is generally parallel with a longitudinal axis of the transrectal probe when the guide member is secured to the transrectal probe. In certain embodiments, interaction between the slot and the rail member constrains lateral movement of the displacement member relative to the guide member. In certain embodiments, interaction between the slot and the rail member constrains the vertical tilting of the displacement member relative to the guide member. In certain embodiments, the displacement member may include a plurality of needle receiving ports oriented vertically or in a single plane relative to each other. In certain embodiments, the guide member may include a pair of guide rails, the displacement member may be configured to displace between the pair of guide rails. 
     In certain embodiments, the access needle may extend beyond the distal end of the guide member when the access needle is displaced to the distal end. In certain embodiments, the access needle may be configured to be locked into position at the distal end. 
     Aspects of the present disclosure may also involve a biopsy guide which may be configured to couple with a transrectal probe and for use in guiding an access needle in a transperineal prostate biopsy procedure. The access needle may be configured to perforate and be positioned within subcutaneous tissue of a perineum at an access site of a target area of a patient. The biopsy guide may include a guide member and a displacement member. The guide member may be configured to operably couple with the transrectal probe and may include a distal end, a proximal end opposite the distal end, and a length between the distal and proximal ends. The displacement member may be supported by the guide member and may be configured to support and displace the access needle along at least a portion of the length of the guide member between the distal and proximal ends while maintaining a fixed trajectory of the access needle. 
     In certain embodiments, may include the transrectal probe. 
     In certain embodiments, may include the access needle. 
     In certain embodiments, the displacement member may slidingly couple with the guide member via a coupling mechanism such that the displacement member is displaceable relative to the guide member. In certain embodiments, the guide member may include a first rail member, and the coupling mechanism may include upper and lower members that sandwich the first rail member. In certain embodiments, the guide member may further include a second rail member opposite the first rail member, the upper and lower members sandwiching the second rail member. In certain embodiments, the fixed trajectory is generally parallel to a longitudinal axis of the transrectal probe. In certain embodiments, the guide member may include a pair of guide rails extending the length, and the displacement member may be positioned between the pair of guide rails and slidingly couple with the pair of guide rails via a coupling mechanism. In certain embodiments, the coupling mechanism may include upper and lower members that sandwich each of the pair of guide rails. 
     In certain embodiments, the guide member may include a sheath in which the probe resides when the guide member is operably coupled with the transrectal probe. 
     In certain embodiments, the biopsy guide further includes a mechanical arrangement between the guide member and the displacement member that at least facilitates the displacement of the access needle along the at least a portion of the length of the guide member, wherein the mechanical arrangement may include at least one of a sliding arrangement, a lead screw, or a parallel bar linkage. 
     In certain embodiments, the guide member operably couples with the transrectal probe via at least one of a sheath arrangement, a ratchet arrangement, a biased collar arrangement, a flexible strap arrangement, a clamping arrangement, or a clamshell collar arrangement. 
     Aspects of the present disclosure also involve a biopsy guide which may be configured to couple with a transrectal probe and for use in guiding an access needle in a transperineal prostate biopsy procedure. The access needle may be configured to perforate and be positioned within subcutaneous tissue of a perineum at an access site of a target area of a patient. The transrectal probe may include a distal end, a proximal end opposite the distal end, and a longitudinal axis between the distal and proximal ends. The biopsy guide may include a displacement member which may be configured to be operably coupled with the transrectal probe and to support and displace the access needle along at least a portion of the transrectal probe. The displacement of the access needle may be along a trajectory that is parallel to the longitudinal axis of the transrectal probe. 
     In certain embodiments, the biopsy guide may further include a guide member operably coupled to the displacement member and by which the displacement member is operably coupled with the transrectal probe. 
     In certain embodiments, at least a portion of the displacement member displaces relative to the guide member when the access needle is displaced along the trajectory that is parallel to the longitudinal axis of the transrectal probe. 
     In certain embodiments, the biopsy guide may further include a mechanical arrangement between the guide member and the displacement member that at least facilitates the displacement of the access needle along the trajectory that is parallel to the longitudinal axis of the transrectal probe, wherein the mechanical arrangement may include at least one of a sliding arrangement, a lead screw, or a parallel bar linkage. 
     In certain embodiments, the guide member may operably couple with the transrectal probe via at least one of a sheath arrangement, a ratchet arrangement, a biased collar arrangement, a flexible strap arrangement, a clamping arrangement, or a clamshell collar arrangement. 
     In certain embodiments, the biopsy guide may further include a mechanical interface by which the displacement member is operably coupled with the transrectal probe and by which the displacement member displaces the access needle along the trajectory that is parallel to the longitudinal axis of the transrectal probe. In certain embodiments, the mechanical interface may include at least one of a sliding arrangement directly between the transrectal probe and the displacement member or a rolling arrangement directly between the transrectal probe and the displacement member. 
     In certain embodiments, the biopsy guide may further include the transrectal probe and wherein the transrectal probe may include a first portion of the sliding arrangement and the displacement member may include a second portion of the sliding arrangement directly engaged in sliding contact with the first portion. In certain embodiments, at least one of the first portion or second portion comprises a slot, a rail, or a bar. 
     In certain embodiments, the biopsy guide may further include the transrectal probe and wherein the sliding arrangement may include at least a portion of the displacement member being in direct sliding contact with an exterior surface of the transrectal probe. 
     In certain embodiments, the biopsy guide may further include the transrectal probe and wherein the rolling arrangement may include a roller bearing arrangement supported on the displacement member being in direct rolling contact with an exterior surface of the transrectal probe. 
     Related art systems and prostate biopsy TPUS methods do not allow free-hand movement of the ultrasound probe, and heavily rely on the axial ultrasound plane to confirm positioning of the biopsy needle or other instruments. Moreover, such systems and methods include extracting prostate tissue specimens by delivering separate punctures into the transperineal tissue. Also, a care provider executing TPUS procedure using related art systems may experience substantial difficulty in freely handling and positioning a biopsy needle at a desired target location of the prostate relying on the sagittal plane in using the TRUS methods. 
     An apparatus in accordance with an embodiment may include an upper mount and a lower mount. The lower mount may be configured to connect with the upper mount to secure a transrectal probe therebetween. The upper mount may be configured to support an access needle, the access needle configured for perforation of subcutaneous tissue of a perineum at an access site of a target area of a patient. The upper mount may be configured to guide the access needle whereby movement of the access needle is fixed relative to movement of the transrectal probe. 
     A system in accordance with an embodiment may include a biopsy guide and a transrectal transducer fixed to the biopsy guide. The biopsy guide may be configured to guide an access needle to perforate an access site in subcutaneous tissue of a perineum, whereby movement of the access needle is fixed relative to a movement of the transrectal transducer. 
     A method of performing a prostate biopsy in accordance with an embodiment may include imaging a prostate in an axial plane and a sagittal plane with a transducer providing a real-time image, locating a target area of the prostate, and positioning an access needle and an access site in subcutaneous tissue of a perineum wherein the access site is at a midpoint between a lateral edge of the prostate and a urethra along a first axis and a midpoint between an anterior capsule and a posterior capsule along a second axis. The method may include guiding a biopsy instrument along a sagittal plane to the target using the real-time image, and obtaining one or more specimens of the prostate through the access needle with a biopsy instrument. 
     Accordingly, there is a demand for transperineal biopsy methods, systems, and apparatus that enables a biopsy that is less burdensome for the patient and for the practitioner performing the biopsy, increased guidance of needle or other biopsy instruments, and with a higher rate of efficacy and lower rate of health risk than related art TPUS and TRUS systems and methods. Apparatus, systems, and methods disclosed herein satisfy these demands. 
     Other implementations are also described and recited herein. Further, while multiple implementations are disclosed, still other implementations of the presently disclosed technology will become apparent to those skilled in the art from the following detailed description, which shows and describes illustrative implementations of the presently disclosed technology. As will be realized, the presently disclosed technology is capable of modifications in various aspects, all without departing from the spirit and scope of the presently disclosed technology. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not limiting. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    shows a side view of a guide secured to a probe in accordance with an embodiment; 
         FIG.  2 A  shows an internal view of a guide fastener in accordance with an embodiment; 
         FIG.  2 B  shows a sheath-based guide fastener in accordance with an embodiment; 
         FIG.  2 C  shows a zip-tie-based guide fastener in accordance with an embodiment; 
         FIG.  3    shows a top view of a guide secured to a probe in accordance with an embodiment; 
         FIG.  4    shows a cross-sectional view of the back of a guide secured to a probe in accordance with an embodiment. 
         FIG.  5    shows a magnified view of a guide secured to a probe in accordance with an embodiment; 
         FIG.  6    is a magnified top view of a guide fastener in accordance with an embodiment; 
         FIG.  7    is a magnified view of a guide in accordance with an embodiment; 
         FIG.  8    is a side view of a biopsy instrument that has penetrated the prostate in accordance with an embodiment; 
         FIG.  9    is a front view of a designated area of the prostate where a biopsy instrument will penetrate in accordance with an embodiment; 
         FIG.  10    is a side view of a biopsy instrument penetrating the prostate in accordance with an embodiment; 
         FIG.  11    is a front view of a designated area of the prostate where a biopsy instrument will penetrate with areas in which the cell or tissue specimen has already been extracted in accordance with an embodiment; 
         FIG.  12    is a top view of a biopsy instrument that has penetrated the prostate in accordance with an embodiment; 
         FIG.  13    is a side view of a prostate and the path of the biopsy instrument; 
         FIG.  14    is a front view of a guide positioned at a designated area of the prostate in accordance with an embodiment; 
         FIG.  15    is a side view of a guide positioned at a designated area of the prostate in accordance with an embodiment; 
         FIG.  16    is a front view of a guide positioned at another designated area of the prostate in accordance with an embodiment; 
         FIG.  17    is a side view of a guide positioned at another designated area of the prostate; 
         FIG.  18    is a front view of a guide positioned at a higher designated area of the prostate, according to one embodiment; 
         FIG.  19    is a right side view of a guide positioned at a higher designated area of the prostate in comparison with that shown in  FIGS.  14 - 17    in accordance with an embodiment; 
         FIG.  20    is a side view of a guide and a biopsy instrument firmly penetrating a fat plane and perineum skin of a patient in accordance with an embodiment; 
         FIG.  21    is a view of an access needle positioned at the access site in accordance with an embodiment; 
         FIG.  22    is a magnified view of the right side of a prostate and a biopsy instrument in accordance with an embodiment; 
         FIG.  23    is an image of the front side of a prostate and a biopsy instrument being retrieved from the prostate, and other targeted areas in accordance with an embodiment; 
         FIG.  24    shows a method for performing a prostate biopsy in accordance with an embodiment; 
         FIG.  25    is an ultrasound image showing a transducer, access needle path extending from an access point at a perineal site to a prostate, and a prostate; 
         FIGS.  26 A- 26 C  show side views of a guide configured with a pivoting mount in accordance with an embodiment; 
         FIG.  27    is an isometric front view of another embodiment of a biopsy guide; 
         FIG.  28    is a front view of the biopsy guide of  FIG.  27   ; 
         FIG.  29    is a side view of the biopsy guide of  FIG.  27   ; 
         FIG.  30    is an isometric front exploded view of the biopsy guide of  FIG.  27   ; 
         FIG.  31 A  is a front isometric view of the upper mount of the biopsy guide; 
         FIG.  31 B  is a front view of the upper mount of the biopsy guide; 
         FIG.  31 C  is a back view of the upper mount of the biopsy guide; 
         FIG.  31 D  is a side view of the upper mount of the biopsy guide; 
         FIG.  31 E  is a bottom view of the upper mount of the biopsy guide; 
         FIG.  31 F  is a top view of the upper mount of the biopsy guide; 
         FIG.  32 A  is a front isometric view of the displacement member of the biopsy guide; 
         FIG.  32 B  is a front view of the displacement member; 
         FIG.  32 C  is a back view of the displacement member; 
         FIG.  33 A  is an isometric front view of the lower mount of the biopsy guide; 
         FIG.  33 B  is a front view of the lower mount; 
         FIG.  34    is front isometric view of an access needle; 
         FIG.  35 A  is a front isometric view of the lower mount; 
         FIG.  35 B  is a front isometric view of the lower mount coupled with the upper mount; 
         FIG.  35 C  is a front isometric view of the lower mount coupled with the upper mount and the sliding platform engaging with the rails of the upper mount; 
         FIG.  35 D  is a front isometric view of the assembly of  FIG.  35 C  with an access needle supported by the sliding platform; 
         FIG.  36    is a front view of another embodiment of the displacement member; 
         FIG.  37 A  is an isometric front view of another embodiment of the biopsy guide; 
         FIG.  37 B  is an isometric front exploded view of the upper mount of the biopsy guide of  FIG.  37 A ; 
         FIG.  37 C  is an isometric back exploded view of the upper mount of the biopsy guide of  FIG.  37 A ; 
         FIG.  37 D  is a front view of the upper mount of the biopsy guide; 
         FIG.  37 E  is a front isometric view of the displacement member of the biopsy guide; 
         FIG.  37 F  is a front view of the displacement member; 
         FIG.  37 G  is a side view of another embodiment of the displacement member with the access needle partially positioned within the top needle receiving port of the vertically extending member; 
         FIG.  37 H  is a front isometric view of another embodiment of the a biopsy guide; 
         FIG.  37 I  is a side view of the biopsy guide of  FIG.  37 H  showing the platform member in various positions relative to the probe; 
         FIG.  37 J  is a front isometric view of another embodiment of an upper mount; 
         FIG.  37 K  is a front view of another embodiment of a biopsy guide; 
         FIG.  37 L  is a side view of the biopsy guide of  FIG.  37 K ; 
         FIG.  37 M  is a front isometric view of another embodiment of a biopsy guide; 
         FIG.  37 N  is a front view of the biopsy guide of  FIG.  37 M ; 
         FIG.  37 O  is a front isometric view of a cinch strap; 
         FIG.  37 P  is a front isometric view of a V-block insert; 
         FIG.  37 Q  is a front view of the biopsy guide of  FIG.  37 M  with a V-block insert of  FIG.  37 P ; 
         FIG.  37 R  is a front isometric view of another embodiment of a biopsy guide; 
         FIG.  37 S  is a front view of the biopsy guide of  FIG.  37 R ; 
         FIG.  37 T  is a front isometric view of another embodiment of a biopsy guide; 
         FIG.  37 U  is a front view of the biopsy guide of  FIG.  37 T ; 
         FIG.  37 V  is a front view of another embodiment of a lower mount; 
         FIG.  37 W  is an isometric front view of another embodiment of a lower mount; 
         FIG.  37 X  is a front view of another embodiment of a lower mount; 
         FIG.  38 A  is a transverse plane or slice view of a prostate depicting the urethra and an access site for penetration of the access needle; 
         FIG.  38 B  is a sagittal plane or slice view of the prostate depicting the urethra and an access site for penetration of the access needle; 
         FIG.  38 C  is the same transverse plane or slice view as  FIG.  38 A , but including a marking device positioned within the urethra for biopsy navigation; and 
         FIG.  38 D  is the same sagittal plane or slice view as  FIG.  38 B , but including a marking device positioned within the urethra for biopsy navigation. 
     
    
    
     DETAILED DESCRIPTION 
     The apparatus, systems, and methods provided herein enable real-time visualization, free-handed, guided, and multi-sample transperineal methods for performing a biopsy. The methods, systems, and apparatus provided herein also enable a complete biopsy of the prostate with only one perforation, or with minimal perforations of a patient’s skin by way of an initial access site, such that the access needle is freely moveable. The biopsy guide may be placed on or fitted to an assortment of ultrasound probes of different sizes and shapes due to an adjustable mounting system. The guide may be configured to fit to the probe using any suitably configured fastening system. For example, the guide may be configured as a sleeve that is formed to slide over an end of a probe and into an operable position. Alternatively, the guide may be configured to fit to a probe using screws, flanges, zip ties, or other temporary, permanent, or semi-permanent fastening systems. 
     In one embodiment, the guide allows biopsies of one or more tissue or cell samples to be obtained through an initial access needle, while providing direct, real-time ultrasound visualization by, for instance, fixing a position of the access needle relative to an ultrasound probe to provide. For example, the guide is fixed to an ultrasound probe that is not fixed and may be freely moveable in operation. Stabilization bars that are built into the guide facilitate the positioning and holding of the perineal skin and subcutaneous tissue to allow positioning of the access needle. The position of the access needle is facilitated by locking the access needle into the subcutaneous tissue of the perineum using a sliding platform that allows a user, such as a medical practitioner or patient caregiver, to place the access needle along a sagittal transducer plane at optimal positions for obtaining prostate biopsies. In some embodiments, upon placement of the access needle into a locked position, for example, in the pelvic floor, a user may then pass a biopsy needle through the access needle to a desired location of the prostate. In yet further embodiments, the passing of the biopsy needle through the access needle and to the prostate may be facilitated by direct sagittal plane visualization based on the alignment of the access needle. 
     Methods and systems provided herein do not require a patient to take antibiotics at any point prior to the biopsy procedure, nor do they require a patient to undergo bowel preparation in advance of the procedure. Methods, systems, and apparatus can reduce or eliminate multiple skin perforations by using a single access location or access site, while allowing multiple extractions of tissue or cell specimens from the prostate. Methods, systems, and apparatus in accordance with embodiments allow for real-time visualization during a free-handed, guided, transperineal approach, while also facilitating a complete assessment of the prostate with, for example, only one perforation of the patient’s skin wherein the access needle is freely moveable in each plane. 
     Methods, systems, and apparatus of embodiments may include and facilitate treatment that uses a cryoablation probe for focal therapy of prostate cancer, a radiofrequency instrument, a thermotherapy instrument, any instrument for treatment of the cancerous area, or a combination of any of these instruments. 
     Methods, systems, and apparatus of embodiments enable planning and performing the free-hand transperineal prostate biopsies under the guidance of a device and of a real-time transducer in the sagittal imaging plane. 
     The biopsy is performed using a system that includes a biopsy guide, a transducer, an access needle, and a biopsy instrument. The access needle may allow the anesthesia to be injected into the patient, and the tissue or cell specimens of the prostate to be extracted. If anesthesia is used, a syringe may be included in the system. The transducer may be an ultrasound probe or any other type of device that is capable of causing a visualization of the prostate in a display device. In embodiments, the biopsy guide may be disposable. In embodiments, the biopsy guide may be formed of materials intended for a single use. In other embodiments, the biopsy guide is reusable. In some embodiments, the biopsy guide may be formed of materials intended for multiple uses. 
     The guide may include a sliding platform, stabilization bars, one or more upper and lower mounts, and a fastener. The upper and lower mounts may be curvilinear in shape. The upper and lower mounts may be positioned proximally or distally along an ultrasound probe, such as a transrectal ultrasound probe. The configuration and positioning of the upper and lower mounts are adjustable based on the shape of the ultrasound probe and the patient’s body habitus. 
     The guide may be made of any material such as a plastic or metallic material. The guide may be disposable and made of a biodegradable plastic material. In other embodiments, the guide may be reusable and made of stainless steel. The dimensions, for example, the length, width, height, depth, and breadth of the sliding platform, stabilization bars, upper and lower mounts, and the fastener may vary and may be adjustable. The variable and adjustable dimensions, for example, of the stabilization bars, provide a user with flexibility in achieving and maintaining the guide in an appropriate ultrasound plane while performing biopsy procedures, while the user’s patients may vary in size and levels of perineal subcutaneous tissue and fat. In a patient with an excessive amount of perineal subcutaneous tissue and fat, a larger stabilization bar will assist in locking the guide in the proper ultrasound plane. 
     The adjustable stabilization bars and mounts may be curvilinear in shape, allowing the guide to be placed proximally or distally along any cylindrical instrument, such as the transrectal ultrasound probe, which is determined by the surgeon based on the shape of the probe and the patient’s body habitus. This allows the guide to be mounted to any assortment of ultrasound probes. Similarly, the platform may, for example, have various thicknesses. 
     The stabilization bars may be fixed to a top portion of the upper curvilinear mounts of the guide, and may extend beyond the front edge of the upper mounts. The stabilization bars may extend beyond the front edge of the upper curvilinear mount by approximately 8 mm. The guide may be approximately 60 mm wide, or the guide may be approximately 50 mm long, for example. The stabilization bars may have grooves for accommodating a sliding platform that is shorter in length than the stabilization bars. The grooves being configured to allow the platform to slide forward and backward along the stabilization bars. 
     An inner portion of the stabilization bars may have built-in grooves. The grooves accommodate a sliding platform which is shorter in length than the stabilization bars. This allows the sliding platform to slide from the back to the front of the stabilization bars. The stabilization bars may include a resistance as to prevent the sliding bar to freely move back and forth on the stabilization bar. This resistance may be introduced by the sliding platform or both the stabilization bar and the sliding platform. The resistance may be provided by a strip of rubber or any other material capable of providing friction or other. The strip may be curvilinear. The resistance may be generated by a mechanical system, such as a spring mechanism. 
     The sliding platform may have a hole through the platform. In some embodiments, the hole is drilled in the center of the platform. The hole can accommodate various types of needles, including access needles having various diameters, for example, spinal needles having a gauge in the range of 14-18. The hole can also accommodate needles having various lengths. The lengths of the needle may depend, in part, on the body habitus. The needle may be a reusable needle, such as a reusable spinal needle. The needle may be a disposable needle, such as a disposable spinal needle. 
     A flange of the guide secures the placement of the access needle to the guide. The flange may be configured to snap into the guide to secure the needle. The flange may be secured to the guide by other securing mechanisms. The flange can be of various shapes and configurations. For example, the flange may be u-shaped. As another example, the flange may have a thin or slim configuration. The guide assists in providing the appropriate angle of penetration and direction of the access needle, or other instruments that may be used in combination with the guide. 
     The hole in the guide is placed so that once the guide is mounted to the ultrasound probe, the drilled hole will be parallel to the sagittal transducer. The drilled hole may also accommodate the tip of a biopsy gun, or any other biopsy instrument. The sliding platform may be interchangeable and may be removed to allow placement of another sliding platform with a different sized to permit different sizes of needles and other instruments. The hole may be configured to accommodate a cryoablation instrument, a radiofrequency instrument, thermotherapy instrument, or any other instrument for diagnosis and treatment of a bodily tissue, including a cancerous area of a prostate. 
     The platform may have or define a predrilled hole in the center of the platform that can accommodate various sizes of needles and instruments. For example, the hole may be configured to accommodate a needle having a range of 14-18 gauges, such as a reusable 14 gauge spinal needle. Central hole placement on the platform enables alignment of the hole with a sagittal transducer when the guide is mounted to an ultrasound probe. The platform may have multiple holes to accommodate various applications and body habitus. Further, the platform may be of various thicknesses. 
     Once the one or more upper curvilinear mounts are placed at the desired location on the transrectal ultrasound probe, the access hole for a needle, such as a 14 gauge reusable spinal needle, will remain a fixed distance from the ultrasound probe. In embodiments, having one or more lower curvilinear mounts, the mounts may be positioned to cradle an upper aspect of the ultrasound probe. 
     At least two lower mounts are provided and may be individually positioned to accommodate various types of probes, which may have variable diameters along their shafts. In embodiments, a probe, such as a transrectal ultrasound probe, may have one or more diameters along the probe’s shaft. In yet further embodiments, one end of the guide may be fixed at a location of the probe having a different diameter than the location where the other end of the guide is fixed. The separate lower mounts allow for the fixation of the guide, even with varying probe diameters. 
     The lower mount of the guide may include a lower right mount and a lower left mount connected by an adjustable mid-joint or fastener. The adjustable mid-joint or fastener allows the guide to be secured to the probe even if the diameter of the shaft of the probe is longer than the width of the lower mount. The mid-joint or fastener may be flexible to allow the right lower mount to form an acute angle with the left lower mount. This also allows for fixation of the guide to a probe shaft that is not circular in shape. 
     The lateral edges on both ends of the lower mounts may contain a notched post. Corresponding locations of the upper mounts contain holes, such as square shaped holes, to accommodate the notched post of a corresponding lower mount. An upper aspect of each hole includes a flange for locking the notched post in a fixed position. This configuration allows the lower mounts and the upper mounts to be secured to each other and to the probe. 
     Methods may include locating a suspicious area, positioning an access needle, and obtaining one or more tissue or cell specimens from an accurate point in the prostate. The method allows for multiple tissue or cell specimens to be obtained from a bodily organ, such as the prostate, and permits access to the prostate from different angles through a single initial access needle. The method may include calculating the volume of the prostate by positioning the access needle at a mid-point in the x axis from the lateral edge of the prostate to the urethra. 
     Methods may be performed using no anesthesia. Alternatively, an anesthetic may be used. For example, the anesthetic may be lidocaine, or any type of local anesthetic. The lidocaine may include 1 or 2% of a lidocaine solution. 
     The suspicious area or bodily organ may be located by using a transducer. The transducer may be any type of probe for accessing and viewing a targeted site or object, such as an ultrasound probe, or any type of transducer capable of providing visualization of the prostate and/or instruments and devices for diagnosis and treatment of the tissue. The biopsy may be performed using a biopsy gun, a suction device, or any type of instrument that is small enough to be introduced through the access needle and capable of extracting the tissue or cell specimen. The biopsy may be performed while the patient is in a dorsal lobothy position, prone position, or any position that allows for access to the perineal area. 
     Methods may include applying an antiseptic solution to the perineal area. The antiseptic solution may include betadine, or any other substance that reduces the possibility of infection, sepsis, or putrefaction. Methods may include applying bacitracin to the skin at the puncture site or any other type of topical preparation for preventing the possibility of infection. 
     Methods may include attaching a needle to a luer lock syringe, which may contain an anesthetic, or any other type of device capable of retaining its contents and dispensing its contents through the needle. A biopsy gun or any other instrument that may be attached to the needle and used for inserting or extracting any substance thru the lumen of the access needle. 
     Methods may include releasing the syringe from the needle after the anesthetic is injected. Methods may include dividing the prostate in three different regions and designating lateral, mid, apical prostate, and may include labeling the tissue or cell specimen containers, which will identify the tissue or cell specimens. 
     Methods may include securing the guide to the probe. This will permit the practitioner to take the biopsy gun as many times as necessary using his/her other hand, and, consequently, extract multiple tissue or cell specimens. It is contemplated that this can be done without assistance of any other person, and that the biopsy gun may also be attached to the guide in order to permit the surgeon to, for example, label the container with the tissue or cell specimen while performing the biopsy. Methods may also include monitoring all the actions in the prostate by way of a display device that provides images captured by the probe. 
     Methods may include moving the needle in x, y, and z planes. By being able to move the needle in x, y, and z planes, the surgeon is capable of extracting tissue or cell specimens from several different areas of the prostate without having to retrieve the needle and preventing other perforation of the patient’s skin. In embodiments, movement of the needle within the patient’s body is facilitated by using a display device. 
     Methods may include removing the access needle from the perineal area. This may be done while the biopsy gun is secured to the access needle or after the biopsy gun has been detached from the access needle. 
     Methods may include realigning the needle in the desired prostate region. If the surgeon wishes to start at the right lateral prostate region and notices that the needle tip is not directed at the lateral region, the surgeon rolls the ultrasound probe slightly and to note that the needle tip is directed to the desired region, then the surgeon may realign the needle to obtain tissue or cell specimen. The surgeon may realign the needle using one hand while having the needle attached to the biopsy gun, which may be attached to the probe through the guide. 
     Methods may include identifying the areas in which biopsy have already been performed. After each extraction of tissue or cell specimen during the biopsy, a hyperechoic streak remains visible on ultrasound display. This allows the surgeon to identify the area of the prostate and that an extraction has been made, as to allow the surgeon to prevent overlap of extractions. 
     In another embodiment, the method includes identifying the path of the urethra. This allows the surgeon from preventing passing the biopsy needle thru or into this path. 
       FIG.  1    is a side view of a guide  100  secured to a probe including a stabilization bar  101 , fasteners  102 , probe  103 , lower mounts  104 , and an upper mount  105 . The stabilization bar  101  is an extension of the upper mount  105 , as further discussed in  FIG.  4   . In embodiments, the distance between the fasteners  102  and the upper mount  105  may be adjustable to accommodate various applications and body habitus. 
       FIG.  2 A  is an internal view of a guide’s fastener, including an aperture  201 , teeth  202 , and a flange  203 . The flange  203  may be an extension of the aperture  201 , which is part of the upper mount  105 . Aperture  201  will allow the teeth  202  to be inserted into the upper mount  105 , and the flange  203  will lock the teeth  202 , which is connected to lower mount  104 , to the upper mount  105 . The aperture  201  with flange  203  and teeth  202  allows for adjusting the height of the guide  100 . 
     In one embodiment, the fastener (e.g., via the aperture  201 , flange  203 , and/or the teeth  202 ) can be configured to fasten the guide  100  to the probe  103  with, e.g., varying levels of tension to provide for adjustments of the relative positions of the guide  100  and the probe  103  even after the guide  100  has been mounted to the probe  103 . For example, the fastener  102  can provide a first level of tension sufficient to hold the position of an access needle (e.g., introduced through a hole or other needle mount of the guide  100 ) rotationally fixed to the probe  103  while still allowing for a forward or reverse sliding of the probe  103  with respect to the guide  100 . By way of example, the forward or reverse sliding adjustment can be performed to adjust the penetration depth of the probe  103  with respect to the patient depending on a size of the patient. Once the final adjustment is made, the fastener can be actuated to final position or tension that will then lock further adjustments of the positioning of the guide  101  relative to the probe  103 . 
     It is noted that the guide’s fastener as described above is one example embodiment among other possible example fasteners that are applicable to various embodiments of the guide  100 . Accordingly, it is contemplated that various embodiments of the guide  100  may use any now known or later developed fastening system that can secure the guide  100  to the probe  103 . 
     By way illustration and not limitation, examples of two fasteners are discussed with respect to  FIGS.  2 B and  2 C .  FIG.  2 B  shows a sheath-based fastener whereby the fasteners  102  are attached to a sheath  211  that is configured to slide over an end of a probe  103  and into an operable position. Although the sheath  211  is shown as a closed sheath, in another embodiment, the sheath  211  can be configured as a sleeve that is open-ended to slide over the probe  103 . By way of example, the sheath  211  can be made of a flexible material (e.g., rubber) to provide for stretching and tension on probe  103 . 
     In another embodiment, as shown in  FIG.  2 C , the guide  100  can be configured with a zip-tie style fastener in place of a lower mount mechanism to secure the guide  100  to the probe  100 . In other embodiments (now shown), the guide  100  may be configured to fit to the probe  100  using screws, flanges, or other temporary, permanent, or semi-permanent fastening systems. In addition, although the fasteners  102  of the guide  100  may be configured as generic and adjustable fasteners that can support probes of a variety sizes and shapes, it is also contemplated that the fasteners can be fit to specific models of probes for customized applications. 
       FIG.  3    is a top view of a guide secured to a probe. This figure includes a sliding platform  301 , a drilled hole  302 , stabilization bars  101 , fasteners  102 , an upper mount  105 , and a probe  103 . As previously described, in one embodiment, the drilled hole  102  can accommodate or support various sizes and/or configurations of needles (e.g., straight needles, curved needles, etc.) and instruments for performing a biopsy so that the needle can be aligned relative to the probe  103 , thereby, also providing an alignment between the needle and an image produced by the ultrasound probe  103 . In one embodiment, the drilled hole  102  can support an access needle through which a biopsy needle or other instrument can be introduced at a known alignment with respect to the probe  103 . In addition, although the hole  102  to support, e.g., an access needle or other instrument is showed in a central midline position, the location of the hole can be configured at any position of the guide  100 . 
       FIG.  4    is a cross-section view of the back of a guide secured to a probe including a sliding platform  301 , drilled hole  302 , stabilization bars  101 , lower mount  104 , upper mount  105 , fasteners  102 , and probe  103 . 
       FIG.  5    is a magnified view of  FIG.  1   .  FIG.  5    demonstrates minimum dimensions of preferred embodiments, which includes stabilization bars  101  and upper mount  105  from 30 mm to 50 mm long; the upper mount  105  with a height ranging from 10 mm to 15 mm; the stabilization bars  101  with a height that is about ⅓ of the height of the upper mount  105 ; fasteners  102  with a height of about 25 mm and 10 mm wide; a lower mount  104  10 mm wide. Additionally, the offset  501  from the distal point of the stabilization bar  105  to the fasteners  102  may be 5 mm. It is contemplated that any of these dimensions may vary, including the stabilization bar  101 , which may be longer than the upper mount  105 . 
       FIG.  6    is a magnified internal view of the guide fastener shown in  FIG.  2   .  FIG.  6    demonstrates minimum dimensions of preferred embodiments. The fasteners  102  may have an aperture  201  to accommodate teeth  202 , wherein the fastener  102  is 5 mm to 10 mm wide. Additionally, the sliding platform  301 , which may be from 12 mm to 25 mm wide, is slightly shorter than the distance between the two stabilization bars  101  as to accommodate the sliding platform while also securing it to the guide  100 . 
       FIG.  7    is a magnified view of the guide depicted  FIG.  3   , without the probe  103 .  FIG.  7    also demonstrates minimum dimensions of preferred embodiments, wherein the height of the upper mount  105  ranges from 5 mm to 10 mm; and the teeth  202  is from 5 mm to 8 mm wide. 
       FIG.  8    is a side view of a biopsy instrument that is about to penetrate the prostate, including a prostate  801 , a probe  103 , a biopsy instrument  802 , a perineum skin  803 , an anus  804 , and a perforation point  805 . The probe  103  is inserted into the anus  804  to provide real-time images of the biopsy, including images of the biopsy instrument  802  and the prostate  801 . It is contemplated that the biopsy instrument  802  includes a needle and any other instrument capable of performing a biopsy. 
       FIG.  9    is a front view of a targeted area  902  of the prostate  801 .  FIG.  10    is a side view of a biopsy instrument penetrating the prostate  801 , including a targeted area  902  of the prostate  801 . The targeted area  902  is reached by biopsy instrument  802  after perforating perineum skin  803 . 
       FIG.  11    is a front view of a targeted area of the prostate where a biopsy instrument will penetrate with areas in which the cell or tissue specimen has already been extracted.  FIG.  11    depicts both an extracted area  1101  and a targeted area  902 . The possibility of viewing the area in which the cell or tissue specimen has already been extracted permits the practitioner to avoid placing the access needle in an area that cell or tissue specimen has already been extracted. This allows the biopsy to be more efficient and more accurate. 
       FIG.  12    is a top view of  FIG.  8   , depicting a prostate  801 , perineum skin  803 , a probe  103 , and a biopsy instrument  802 .  FIG.  13    is a right side view of a prostate and the path of the biopsy instrument including the path of the biopsy instrument  1301  and the perforation point  805 .  FIG.  13    illustrates that only one initial perforation to the skin of the patient is necessary in order to extract one or more cell or tissue specimens. 
       FIG.  14    is a front view of a guide determining a lower targeted or suspicious area  1401  of the prostate in which to penetrate the biopsy instrument, a prostate, and a probe.  FIG.  16    is a front view of a guide determining a mid-target or suspicious area  1601  of the prostate in which to penetrate the biopsy instrument, a prostate, and a probe.  FIG.  18    is a front view of a guide determining a higher targeted or suspicious area  1801  of the prostate in which to penetrate the biopsy instrument, a prostate, a probe.  FIGS.  14 ,  16 , and  18    demonstrates the variety of angles and positions in which a guide may be positioned in order to reach several regions of the prostate, such as the lateral region, mid region, and apical region. In order to the able to reach these areas,  FIGS.  14 , 16 , and  18    demonstrate how the upper mount  105 , the stabilization bars  101 , or a combination of thereof can adjust in order to reach a lower targeted or suspicious area  1401 , a mid-targeted or suspicious area  1601 , or a higher targeted or suspicious area  1801  of the prostate. 
       FIGS.  15 ,  17 , and  19    demonstrate a side view of  FIGS.  14 ,  16 , and  18    and the paths of the biopsy instrument  1301  taken by a biopsy instrument to reach lower targeted or suspicious area  1401 , a mid-targeted or suspicious area  1601 , or a higher targeted or suspicious area  1801  of the prostate. 
       FIG.  20    is a right side view of a guide, and a biopsy instrument firmly penetrating a fat plane of perineum skin, including offset  501  of a stabilization bar  101 . This allows for stabilization in a patient with an excessive amount of perineal subcutaneous tissue, fat, or a combination thereof. A larger stabilization bar  101  will assist in locking the guide in the proper ultrasound plane. Accordingly, the offset  501  may longer than 5 mm for these purposes. 
       FIG.  21    is a front view of a prostate, a probe, a targeted or suspicious area, wherein the biopsy instrument may reach any area of the prostate.  FIG.  21    demonstrates that the biopsy instrument can reach the entire prostate while using only one perforation point  805 . After obtaining one cell or tissue specimen, the biopsy instrument  802  may be partially retrieved from the perineum area at a point in which the distal point of the biopsy instrument  802  is redirected to another targeted or suspicious area. Then, the biopsy instrument (usually the needle of the biopsy instrument) is inserted to the second targeted or suspicious area for obtaining a cell or tissue specimen of another area of the prostate. 
       FIG.  22    is a magnified view of the right side of a prostate and a biopsy instrument.  FIG.  22    depicts the location of the biopsy instrument inside the prostate and the other paths in which the biopsy instrument may take utilize for additional samples or retrieval. In embodiments, the biopsy needle or other instruments do not reach the initial part of the penis, which is in a different plane from the prostate. 
       FIG.  23    is an image of the front side of a prostate and a biopsy instrument being retrieved from the prostate, and other targeted areas.  FIG.  23    shows a procedure being applied to the apical region of the prostate. 
     The urethra should be avoided in any part of the procedure, but it is mostly important when extracting cell or tissue specimens from the apical region of the prostate, when the chances of perforation is greater. After several extractions, the practitioner is able to see the blood streak from where the cell or tissue specimen was taken so as to avoid overlapping. 
     After this procedure, the patient may be put with restriction for no more than 1 day. If the patient is put on restriction for 1 day, after the one-day-restriction, no restriction is made. 
     In an embodiment, the biopsy system performs the processes  2400  of  FIG.  24   . At  2401 , a patient is prepared for the biopsy procedure by having the patient get into a lithotomic position, prone position, or any position that allows for access to the perineal area. The biopsy procedure may be a prostate biopsy. In some embodiments, the patient’s scrotum is elevated using, for example, two strips of plastic tape. The perineum is prepared with an antiseptic solution to the perineal area, for example, the antiseptic solution may include betadine. 
     At  2402 , a target area or object, such as the prostate, is imaged. Imaging may be performed with a transducer, such as an ultrasound probe. Imaging of a target area may be in a sagittal and/or axial plane and may be performed in real-time with direct visualization. Utilizing the real-time image, a user can identify areas of interest, e.g. suspicious areas or the target area or object at  2403 . 
     The user may determine an access site for positioning an access needle. At  2404 , an access needle is positioned at an access site in subcutaneous tissue of the perineum. The access site may be at a midpoint between a lateral edge of the prostate and the urethra along an x axis, and a midpoint between an anterior capsule and a posterior capsule along a y axis. The access needle is guided and positioned at the access site by using the guide. 
     At  2405 , a biopsy instrument is guided to the target or suspicious areas or object. The biopsy instrument may include a biopsy needle. The guiding of the biopsy instrument can be facilitated by using the real-time visualization provided by the transducer. Real-time visualization also facilitates obtaining tissue or cell specimens from an accurate point in the prostate, for example. The method allows for one or more tissue or cell specimens to be obtained from a bodily organ, such as the prostate at  2406 , and permits access to the prostate from different angles through a single initial access needle. 
     At  2407 , the biopsy instrument may be retrieved and removed from the patient. The method may include calculating the volume of the prostate by positioning the access needle at a mid-point in x axis from the lateral edge of the prostate to the urethra. 
       FIG.  25    shows an ultrasound  2501  showing a transrectal probe  2503  and an access needle guide line  2505 . The needle guide line enables the practitioner to observe a needle path whereby the access needle has contacted the prostate  2507 , thereby enabling the practitioner to avoid overlapping sampling, and to avoid perforating the prostate. 
       FIGS.  26 A- 26 C  show side views of an alternative embodiment of a guide  2600  secured to a probe including a stabilization bar  101 , fasteners  102 , probe  103 , lower mount  104 , and an upper mount  105 . The stabilization bar  101  is an extension of the upper mount  105 , as further discussed in  FIG.  4   . In embodiments, the distance between the fasteners  102  and the upper mount  105  may be adjustable to accommodate various applications and body habitus. 
     The guide  2600  includes a sliding platform  301 . The guide is fitted to the probe  103  by a sleeve  2607 . The sleeve  2607  is formed by the lower mount  104  and the upper mount  105 . The sleeve  2607  may be configured to slide over an end of the probe  103  into an operable position as shown in  FIGS.  26 A- 26 C . The sleeve  2607  is a partial sleeve that has an opening at both ends of the sleeve  2607  to enable slidable mounting to and removal from the probe  103 . 
     The sliding platform  301  of the guide  2600  may be pivotably mounted to enable movement in a direction perpendicular to a longitudinal axis of the probe  103 , as shown in  FIGS.  26 A- 26 C . In particular  FIGS.  26 A- 26 C  show that the sliding platform  103  is fixed to the guide at a pivot point  2608 . The sliding platform  103  is configured to pivot at pivot point  2608  to enable, for example, normal or vertical adjustment of an access needle (not shown) in directions perpendicular to a longitudinal axis of the probe  103  while ensuring that a longitudinal axis of the access needle (not shown) remains parallel to the longitudinal axis of the probe  103 . 
     For example,  FIG.  26 A  shows a sliding platform  301  in a first position at which a lateral planar surface of the platform  301  extends in a direction parallel to the longitudinal axis of the probe  103 .  FIG.  26 B  shows the sliding platform  301  pivoted to a second position wherein a front end the platform  301  is disposed a distance from the probe  103  that is greater than a distance between an opposite rear portion of the platform  301  and the probe  103 .  FIG.  26 C  shows the sliding platform  301  pivoted to a third position wherein the rear end of the platform  301  is disposed a distance from the probe  103  that is greater than a distance between the opposite front end of the platform  301  and the probe  103 . 
     In another embodiment, the method may be performed without the patient taking antibiotics or undergoing bowel preparation before having the procedure. During the procedure, the practitioner may administer an anesthetic to the patient, for example, lidocaine, or any type of local, anesthetic. The lidocaine may be included in a solution having 1% of lidocaine. 
     In an embodiment, the suspicious area is located by using a transducer. The transducer may be any type of transrectal robe for prostate cancer, such as an ultrasound probe, or any type of transducer capable of imaging the prostate and the extraction device. The biopsy may be performed using a biopsy gun, a suction-mechanism, or any type of instrument that is small enough to be introduced through the access needle and capable of extracting the tissue or cell specimen. The biopsy may be performed while the patient is in a lithotomy position, prone position, or any position that allows for access to the perineal area. 
     In another embodiment, methods may include applying an antiseptic solution to the perineal area such as betadine, or any other substance that reduces the possibility of infection, sepsis, or putrefaction. 
     In another embodiment, the ultrasound probe may be a B&amp;K 8848 transrectal ultrasound probe, or any other ultrasound capable of causing visualization of the prostate and the extraction device. The frequency range may be 5 -12 MHZ, and the focal range may be 3-60 mm. The ultrasound probe may be able to cause the visualization of the prostate and extraction devices at least in the axial plane, sagittal plane, or a combination thereof. 
     In another embodiment, methods may include attaching a needle to a luer lock syringe, which may contain an anesthetic, or any other type of device capable of retaining its contents and to dispense its contents through the needle. A biopsy gun or any other instrument may be attached to the needle for inserting or extracting any substance through the lumen of the access needle. 
     In another embodiment, the method includes releasing the syringe from the needle after the anesthetic is injected. The method may include dividing the prostate in three different regions and designating lateral, mid, apical prostate, and may include labeling the tissue or cell specimen containers, which will identify the tissue or cell specimens. 
     In another embodiment, a biopsy gun may be an 18 gauge biopsy gun, or any other size that is capable of being coaxially inserted thru the lumen of the access needle. 
     In another embodiment, methods may include securing the guide to the probe. This will permit the practitioner to take the biopsy gun as many times as necessary using his or her other hand, and, consequently, extract multiple tissue or cell specimens. It is contemplated that this can be done without assistance of any other person, and that the biopsy gun may also be attached to the guide in order to permit the surgeon to e.g. label the container with the tissue or cell specimen while performing the biopsy. The method may also include monitoring all the actions in the prostate thru a display device, which will transmit images captured by the probe. 
     In another embodiment, methods may include moving the needle in x, y, and z planes. By being able to move the need in x, y, and z planes, the surgeon is capable of extracting tissue or cell specimens from several different areas of the prostate without having to retrieve the needle and preventing other perforation of the patient’s skin. 
     Methods may further include removing the access needle from the perennial area. Removal of the access needle may be performed while the biopsy gun is secured to the access needle or after the biopsy gun has been detached from the access needle. 
     Methods may include realigning the needle in the desired prostate region. If the surgeon wishes to start at the right lateral prostate region and notices that the needle tip is not directed at the lateral region, the surgeon rolls the ultrasound probe slightly and to note that the needle tip is directed to the desired region, then the surgeon may realign the needle to obtain tissue or cell specimen. The surgeon may realign the needle using one hand while having the needle attached to the biopsy gun, which may be attached to the probe through the guide. 
     Methods may include identifying the area in which a biopsy has already been performed. After each extraction of tissue or cell specimen during the biopsy, a hyperechoic streak remains visible on ultrasound display. This allows the surgeon to identify the area of the prostate and that an extraction has been made, as to allow the surgeon to prevent overlap of extractions. 
     In another embodiment, methods may include identifying the path of the urethra. This allows the surgeon from preventing passing the biopsy needle thru or into this path. In another embodiment, the method includes pressuring the perineum. In yet another embodiment, the method includes applying bacitracin to the skin at the puncture site or any other type of topical preparation for preventing the possibility of infection. In another embodiment, positioning the access needle is performed without the need of a biopsy grip, wherein the guide provides the precise point for the biopsy. 
     An apparatus and system in accordance with embodiments discussed above is used to carry out these methods. In an alternative embodiment of apparatus and systems, a guide may not include a lower mount, and may include an access needle. The guide includes a stabilization bar, sliding platform, a hole located in approximately the center of the platform, an upper mount, teeth, aperture, arms, and a connector. The access needle includes a hub and is secured to the guide. The teeth may be part of, or may be attached to, a lower mount. The teeth may be inserted into the aperture in order to secure the guide to a probe, for example. It is contemplated that the combination of the aperture and the teeth may form a fastener mechanism. In embodiments, connector is part of, or may be attached to, an access needle, and may be secured to the upper mount in order to provide stabilization of the access needle and to allow the practitioner to move the access needle by merely moving, for example, a probe that may be secured to the guide. 
     A connector and a hub permit the use of various other instruments such as, for example, a non-biopsy instrument, to be secured. A biopsy instrument may be inserted into the access needle in order to reach a targeted area. The upper mount may include arms. In embodiments, the arms may be shorter, longer, or may not exists, in which case the aperture is disposed directly in the upper mount. When the aperture is directly in the upper mount, upper mount may be longer, thicker, or a combination thereof. 
     In some embodiments, the guide may include lower mounts that have teeth. Arms may extend from the upper mount to allow the height of the guide to be adjusted and to be placed farther from or closer to the probe. The arms permit the access needle to be maintained at a certain distance from a probe. In embodiments, the material of the guide may be a plastic or any other material, including other plastic materials, or any other material that is cost effective. In embodiments, the guide may be reusable and may be formed with a stainless steel. The lower mount may be curvilinear and flexible to allow the lower mount to bend if necessary to secure the guide to the probe. 
     Reference is made to  FIG.  27   -35D, which depict various views of another embodiment of a transperineal biopsy guide  2700 . As with the previously described embodiments, the biopsy guide  2700  may couple with a transrectal probe and may be used in guiding an access needle in a transperineal prostate biopsy procedure. While reference will be made to the embodiment in  FIG.  27   -35D, aspects of the previously described embodiments may be incorporated into the present embodiment without limitation. And, aspects of the present embodiment may be similarly incorporated into the previously described embodiments without limitation. 
     To begin, reference is made to  FIGS.  27 - 30   , which depict, respectively, a front isometric view, a front view, a side view, and a front isometric exploded view of the transperineal biopsy guide  2700 . As seen in the figures, the biopsy guide  2700  includes an upper mount  2702  and a lower mount  2704 . The lower mount  2704  includes a probe coupling or fastening mechanism  2706  to couple the lower mount  2704  with a transrectal probe (not shown in  FIGS.  27 - 28   , but shown in  FIGS.  1 ,  2 B, and  3 - 6   , for example). The lower mount  2704  additionally includes an upper mount coupling mechanism  2714  to couple the lower mount  2704  with the upper mount  2702 . While  FIGS.  27 - 30    depict a single coupling mechanism  2706 , it is foreseen that the biopsy guide  2700  may include more than one coupling mechanism  2706 , as shown and described in previous embodiments. 
     The upper mount  2702  may couple with the lower mount  2704  and may include a guide member  2708  and a displacement member, translating member, or sliding platform  2710 . The displacement member  2710  may couple with an access needle  2712  and be supported by the guide member  2708 . More particularly, the displacement member  2710  may slidingly couple with the guide member  2708  such that the displacement member  2710  and the access needle  2712  are guided along a trajectory that is fixed relative to the guide member  2708  and the transrectal probe. The trajectory of the access needle  2712  may be generally parallel with a longitudinal axis of the transrectal probe when the biopsy guide  2700  is coupled with the probe. 
     Reference is made to  FIGS.  31 A- 31 F , which depict various views of the guide member  2708  of the upper mount  2702  of the biopsy guide  2700 .  FIG.  31 A  is a front isometric view of the guide member  2708 ;  FIG.  31 B  is a front view of the guide member  2708 ;  FIG.  31 C  Is a back view of the guide member  2708 ;  FIG.  31 D  is a side view of the guide member  2708 ;  FIG.  31 E  is a bottom view of the guide member  2708 ; and,  FIG.  31 F  is a top view of the guide member  2708 . 
     As seen in the figures, the guide member  2708  includes a distal end  2716 , a proximal end  2718  opposite the distal end  2716 , and a longitudinal axis  2720  extending through the distal and proximal ends  2716 ,  2718 . As described herein locational orientations of distal and proximal are relative to the patient or, more particularly, the perineum of the patient. As such, distal generally refers to towards the patient and proximal refers to away from the patient. 
     Referring back to the figures, the guide member  2708  further includes a base platform  2722  extending substantially perpendicularly between a pair of vertical extension members  2724 . Atop each of the vertical extension members  2724  is a guide rail or stabilization bar  2726  that is adapted to slidingly engage with and allow the displacement member  2710  to translate along a trajectory that is parallel with the longitudinal axis  2720  of the guide member  2708 . 
     As best seen in  FIGS.  31 A and  31 C , each of the guide rails  2726  includes a generally rectangular member  2728  that is perpendicularly oriented to the vertical extension members  2724 . The rectangular member  2728  extends from the proximal end  2718  to the distal end  2716  of the guide member  2708 . The vertical extension members  2724  couples with a bottom surface  2730  of the rectangular member  2728 . An outer lateral edge of the rectangular member is coupled with a side member  2732  that extends from the proximal end  2718  to the distal end  2716  of the guide member  2708 . A distal member or flange  2734  extends inwardly from the rectangular member  2728  a distance that is equal to the width of the rectangular member  2728 . More particularly, the distal member  2734  includes a rounded inner edge  2736  that is coplanar, at its apex, with an inner edge  2738  of the rectangular member  2728 . The distal member  2734  may include a planar distal face or surface  2740  with an opening  2742  formed therein. The opening  2742  may facilitate an access point for injection molding. As with previously described embodiments, the guide rails  2726  and, more particularly, the distal face  2740  of the guide rails  2726  may facilitate the positioning and holding of the perineal skin and subcutaneous tissue to allow positioning of the access needle  2712 . 
     As seen in  FIGS.  31 A,  31 C, and  31 F , a top surface  2744  of the rectangular member  2728  includes a stop feature  2746  to secure or lock the displacement member  2710  in a distal or deployed condition or position. The stop feature  2746  is a ramp that distally slopes upward until the apex of the ramp at which point the ramp distally slopes downward. In the distal position, the displacement member  2710  is at a distal-most position and abuts or is adjacent a proximal face  2748  of the distal member  2734 . The distal member  2734 , thus, prevents further distal movement of the displacement member  2710  and the stop feature  2746  restrains proximal movement a certain amount. In certain embodiments, as seen in the figures, the proximal end  2718  of the rectangular member  2728  is open such that the displacement member  2710  can be slidingly engaged with the rectangular member  2728 . 
     As seen in  FIGS.  31 A and  31 D- 31 F , the base platform  2722  extends about one half of the overall longitudinal distance of the guide rails  2726 . In this way, the guide rails  2726  extend beyond both the base platform  2722  and the vertical extension members  2724  such that the guide rails  2726  may contact the perineal skin and subcutaneous tissue of the patient but not a distal edge  2750  of the base platform  2722  or a distal edge  2752  of the vertical extension members  2724 . And since a distal portion of the lower mount  2704  lies generally flush with the distal edge  2750  of the base platform  2722 , the lower mount  2704  also may be spaced apart from the skin of the patient during the biopsy procedure. In this way, in certain embodiments, the guide rails  2726  may contact the skin of the patient while the other portions of the guide  2700  remain spaced apart from the patient’s skin. 
     As seen in  FIG.  31 D , the distal edge  2752  of the vertical extension member  2724  is arcuate and a proximal edge  2754  of the vertical extension member  2724  includes a semi-circular path about halfway between the base platform  2722  and the guide rails  2726 . As seen in  FIGS.  31 E- 31 F , the base platform  2722  includes a pair of channels  2756  extending parallel to each other and extending longitudinally. These channels  2756  may coaxially align with snap features  2758  in the upper mount coupling mechanism  2714  of the lower mount  2704  to facilitate the upper mount  2702  being coupled with the lower mount  2704 . Once the channels  2756  and the snap features  2758  are aligned, the upper and lower mounts  2702 ,  2704  may be snapped together such that the snap feature  2758  extends through the channels  2756  to securely couple the mounts together. While the figures show channels  2756  and snap features  2758 , other mechanisms are possible to couple the upper and lower mounts  2702 ,  2704 . For example, the base platform  2722  and the upper mount coupling mechanism  2714  may each include through holes that coaxially align. And, screws or nuts/bolts may be used to secure the mounts  2702 ,  2704  together. 
     As seen in  FIGS.  31 B- 31 C and  31 E , the bottom surface  2762  of the base platform  2722  includes a rectangular rail or protrusion  2764  extending longitudinally. The top surface of the base platform  2722  includes a longitudinally extending groove, which may be used to align the guide member  2708  with the sagittal plane of the ultrasound probe. As seen in  FIG.  31 E , the channels  2756  extend through the rail  2764 . As will be described subsequently, the rail  2764  may engage with a platform  2766  of the upper mount coupling mechanism  2714  of the lower mount  2704  so as to align the upper and lower mounts  2702 ,  2704  upon coupling together. 
     Reference is made to  FIGS.  32 A- 32 C , which depict, respectively, a front isometric view, a front view, and a back view of the displacement member  2710 . As described previously, the translating or displacement member  2710  may be coupled with the guide rails  2726  of the guide member  2708  so as to be displaceable or slidable between the proximal end  2718  of the guide member  2708  to the distal end  2716 . Thus, when the access needle  2712  is coupled with the displacement member  2710 , the access needle  2712  is also displaceable between the proximal end  2718  of the guide member  2708  to the distal end  2716 . 
     As seen in the figures, the displacement member  2710  includes a central vertically extending member  2760  having five needle receiving ports  2768  formed therein. Each needle receiving port  2768  includes an opening  2770  extending from a distal end  2772  to a proximal end  2774  of the displacement member  2710 . Each of the openings  2770  of the needle receiving ports  2768  are generally vertically aligned with each other and each includes a trajectory axis  2776  defining a trajectory of the access needle  2712  when positioned within the opening  2770 . The trajectory axis  2776  is generally parallel to the longitudinal axis  2720  of the guide member  2708  when the displacement member  2710  is coupled with the guide member  2708 . The trajectory axis is also generally parallel with a longitudinal axis of the probe when the biopsy guide  2700  is coupled with the probe. Thus, the trajectory axis  2776  of the access needle  2712  may be generally fixed or constant, in a generally parallel orientation to the previously described axes, as the displacement member  2710  displaces distal-proximal relative to the guide member  2708 . 
     A particular needle receiving port  2768  may be chosen based on a desired distance from the probe. Thus, if a physician desires that the access needle  2712  should be positioned nearer the probe, a particular needle receiving port  2768  may be chosen that is at the bottom of the displacement member  2710 . In certain embodiments, the openings  2770  of the needle receiving ports  2768  may be vertically spaced apart about 5 mm. In certain embodiments, the openings  2770  of the needle receiving ports  2768  may be vertically spaced apart about 3 mm. In certain embodiments, the openings  2770  of the needle receiving ports  2768  may be vertically spaced apart about 4 mm. In certain embodiments, the openings  2770  of the needle receiving ports  2768  may be vertically spaced apart at any interval between about 2 mm to about 6 mm, among other distances. 
     While the vertically extending member  2760  includes five needle receiving ports  2768 , it is foreseen that more or less ports may be included in the displacement member  2710  without limitation. 
     The displacement member  2710  further includes a coupling mechanism  2778  to displaceably couple the displacement member  2710  and the guide rails  2726 . The coupling mechanism  2778  includes a pair of lower tab members  2780  extending laterally out and away from the vertically extending member  2760 . When coupled with the guide rails  2726 , the lower tab members  2780  may abut or be positioned adjacent the bottom surface  2730  of the rectangular member  2728 . The tab members  2780  include a planar top surface  2782  that may provide sliding contact with the bottom surface  2730  of the rectangular member  2728 . The planar contact between the surfaces may contribute to stability of the displacement member  2710  relative to the guide rails  2726  by reducing vertical tilt of the displacement member  2710 . 
     The coupling mechanism  2778  further include an upper member  2784  positioned above the lower tab members  2780 . A bottom surface  2786  of the upper members  2784  may abut or be positioned adjacent the top surface  2744  of the rectangular member  2728  when the displacement member  2710  is coupled with the guide rails  2726 . The bottom surface  2786  of the upper members  2784  is planar and, thus, the planar contact between the surfaces may contribute to stability of the displacement member  2710  relative to the guide rails  2726  by reducing vertical tilt of the displacement member  2710 . The upper members  2784  and the lower tab members  2780  operate to sandwich the rectangular members  2728  of the guide rails  2726  when the displacement member  2710  is coupled with the guide member  2708 . 
     The coupling mechanism  2778  further includes a lateral brace mechanism  2788  at lateral ends of the upper members  2784 . The lateral brace mechanism  2788  includes an upside-down U-shaped member  2790  having three inner surfaces  2792  that define a longitudinal extending channel  2794  therein. The channel  2794  may receive the side members  2732  therein when the displacement member  2710  couples with the guide rails  2726 . In this way, the lateral brace mechanism  2788  may contribute to stability of the displacement member  2710  relative to the guide rails  2726  by reducing lateral tilt of the displacement member  2710 . It is foreseen that the displacement member  2710  may not include the lateral brace mechanism  2792  and may instead only include the upper member  2784  and the lower tab members  2780 . Alternatively, it is foreseen that the displacement member  2710  may not include the upper member  2784  and the lower tab members  2780 , but may only include the lateral brace mechanism  2792 . Additionally and alternatively, other mechanisms are possible to facilitate the displacement member  2710  displacing between the proximal and distal ends  2718 ,  2716  of the guide member  2708 . For example, the guide member  2708  could include longitudinally extending rods (not shown) and the displacement member  2710  may include a sleeve that engages and is guided by the rods. In such an embodiment, the rods may be adapted to slide within the openings  2770  of the needle receiving ports  2768  with or without modification to the displacement member  2708 . 
     Still referring to  FIGS.  32 A- 32 C , flanges  2796  extend laterally from the upside-down U-shaped members  2790 , which may act as grasping points for the physician. The flanges  2796  extend inwardly and are coplanar with a back wall member  2798  that spans between the upside-down U-shaped members  2790 , the vertically extending member  2760 , and the upper members  2784 . The back wall member  2798  may function to provide rigidity between the various components of the displacement member  2710 . As seen in  FIG.  32 C , a proximal side  2800  of the needle receiving ports  2768  includes keyed features to lockingly engage the access needle  2712  such that it does not rotate once it is coupled with the port  2768 . 
     Reference is made to  FIGS.  33 A and  33 B , which depict, respectively, a front isometric view and a front view of the lower mount  2704  of the biopsy guide  2700 . As previously described, the upper mount coupling mechanism  2714  includes the snap features  2758  to couple with the channel  2756  in the base platform  2722 . Each of the snap features  2758  may be vertical flanges  2802  with a lip  2804  at its vertical termination. As the inner surfaces defining the channels  2756  contact the vertical flanges  2802 , the inner surfaces compress the lips  2804  together relative to each other until the flanges  2802  “snap” or expand outwardly relative to each other such that the lips  2804  are on a top surface of the base platform  2722 . The vertical flanges  2802  extend from the platform  2766  of the upper mount coupling mechanism  2714 . The platform  2766  is coupled with the probe coupling mechanism  2706 , which, as seen in the figures, may be a snap-grip or snap-clip type of hose or tube clamp. The mechanism  2706  may include a first and a second arm member  2804 ,  2806  extending from opposite sides  2808  of the platform  2766 . The arm members  2804 ,  2806  are flexible and designed to wrap around a portion of the probe fitted within the opening formed by the first and second arms  2804 ,  2806 . The first arm member  2804  includes a first clamping structure  2810  including an upper row of teeth  2812  and a lower smooth sliding surface  2814 . The second arm member  2806  includes a second clamping structure  2816  including an upper smooth sliding surface  2818  and a lower row of teeth  2820 . The first and second clamping structures  2810 ,  2816  work together to provide a clamping or gripping function to securely support the transrectal probe to the lower mount  2704  and, thus, the upper mount  2702 . 
     In operation, a transrectal probe is positioned within the opening between the first and second clamping structures  2810 ,  2816 . The physician may determine a desired position on the probe based on the patient’s anatomy, the particular transrectal probe, or the particular procedure to be performed, among other possible criteria. Once a position for the lower mount  2704  is chosen, the physician may cause the first and second arm members  2804 ,  2806  to be contracted relative to each other by pushing on the outer ends  2822  of the clamping structures  2810 ,  2816 , respectively. As the clamping structures  2810 ,  2816  converge relative to each other, the lower row of teeth  2820  on the second clamping structure  2806  is received within an opening  2824  formed between the upper row of teeth  2812  and the lower smooth surface  2814 . The upper row of teeth  2812  are caused to engage with the lower row of teeth  2820 . Additionally, the upper smooth surface  2818  is caused to slide on an inner smooth surface  2826  of the first arm member. And, the lower smooth sliding surface  2814  is caused to slide on a lowest smooth surface  2828  on the second clamping structure  2816 . The teeth of the upper and lower row  2812 ,  2820  are arranged in a saw tooth like manner such that when they are increasingly engaged with each other the teeth grip each other and resist moving in the opposite direction. Once engaged, the teeth may be disengaged by pulling on a tab  2830  on a bottom portion of the first clamping structure  2810 . Pulling on the tab  2830  allows the teeth  2812 ,  2820  to disengage with each other and the flexible nature of the first and second arms  2804 ,  2806  are caused to spring back into the shape shown in  FIG.  33 B . As seen in  FIG.  33 B- 33 B , an inner surface  2834  of the first and second arms  2804 ,  2806  includes a gasket  2832  that may be flexible and deformable to provide for a gripping surface between the probe and the lower mount  2704 . 
     Reference is made to  FIG.  34   , which depicts a front isometric view of an access needle  2712 . As seen in the figure, the needle  2712  includes a distal end  2836  and a proximal end  2838  opposite the distal end  2836 . At the distal end  2836  is the bevel  2840  extending distally from a shaft  2842 . Within the shaft  2842  is a lumen  2844  for communication of fluids or, in the case of the access needle  2712 , a shaft of a smaller gage biopsy needle. The proximal end  2838  of the needle  2712  includes a hub  2846  with ridges  2848  extending longitudinally around a circumference of the hub  2846 . The ridges  2848  may engage with corresponding and negatively shaped features on the proximal side  2800  of the needle receiving ports  2768 . 
     The following discussion will focus on use of the biopsy guide  2700  and will refer to  FIGS.  35 A- 35 D , which depict, respectively: a front isometric view of the lower mount  2704 ; a front isometric view of the lower mount  2704  coupled with the upper mount  2702 ; a front isometric view of the lower mount  2704  coupled with the upper mount  2702  and the displacement member  2710  positioned at a proximal end of the guide member  2708 ; and, a front isometric view of the lower mount  2704  coupled with the upper mount  2702  and the displacement member  2710  positioned at a proximal end of the guide member  2708  with the access needle  2712  positioned within one of the needle receiving ports  2768 . 
     As seen in  FIG.  35 A , the lower mount  2704  is positioned with the first and second clamping structures  2810 ,  2816  of the first and second arm members  2804 ,  2806  uncoupled such that a transrectal probe may positioned between the arm members  2804 ,  2806 . While it is not depicted in the figures, the first and second clamping structures  2810 ,  2816  may be engaged with each other or coupled as described previously to grasp the probe between the arm members  2804 ,  2806  and against the gasket  2832 . 
     As seen in  FIG.  35 B , the upper mount  2702  may be coupled with the lower mount  2704 . More particularly, the vertical flanges  2802  on the platform  2766  of the upper mount coupling mechanism  2714  may be engaged with or snapped together with the channels  2756  on the base platform  2722  of the guide member  2708 . 
     As seen in  FIG.  35 C , the displacement member  2710  may be engaged with the guide member  2708 . More particularly, the distal end  2772  of the displacement member  2710  is longitudinally aligned with the proximal end  2718  of the guide member  2708  such that the proximal ends of the guide rails  2726  are positioned to extend into the corresponding features of the displacement member  2710 . That is, the rectangular member  2728  is aligned with the opening between the upper members  2784  and the lower tab members  2780 , and the vertically extending side members  2732  are aligned with the channels  2794  between the inner surfaces  2792  of the upside-down U-shaped member  2790  of the displacement member  2710 . Once aligned, the displacement member  2710  is displaced, moved, or translated into engagement with the guide member  2708 , as seen in  FIG.  35 C , which depicts the displacement member  2710  in a proximal-most position. 
     As seen in  FIG.  35 D , the access needle  2712  is coupled with the displacement member  2710 . More particularly, the bevel  2840  and shaft  2842  of the access needle  2712  are extended through the proximal side  2800  of a particular opening  2770  of a needle receiving port  2768  until the hub  2846  of the access needle  2712  engages with the proximal side  2800  of the port  2768 . The ridges  2848  of the access needle  2712  may engaged with corresponding features within the opening  2770  of the port  2768  such that the access needle  2712  remains coupled with the displacement member  2710 . The access needle  2712  may be restrained from rotating by the ridges  2848 . In certain embodiments, the access needle  2712  may be secured to the displacement member  2710  by, for example, a threaded features on the hub  2846  and openings  2770  of the ports  2768  such that the needle  2712  and the displacement member  2710  may be threadably engaged and disengaged with each other. 
     In the orientation shown in  FIG.  35 D , the displacement member  2710  and the access needle  2712  are in a proximal-most position or condition. As seen in the figure, in this particular embodiment, the bevel  2840  of the access needle  2712  lies about flush with the planar distal face  2740  of the distal member  2734 . In other embodiments or with a different sized needle  2712 , the bevel  2840  of the access needle  2712  may extend beyond the distal face  2740  of the distal member  2734  when the displacement member  2710  is in the proximal-most position, or the bevel  2840  of the access needle  2712  may be positioned proximal of the distal face  2740  of the distal member  2734  when the displacement member  2710  is in the proximal-most position. 
     In certain embodiments where the bevel  2840  of the access needle  2712  does not extend past the distal face  2740  of the distal member  2734 , the physician may use the distal member  2734  to manipulate the perineal skin and subcutaneous tissue of the patient while having the displacement member  2710  coupled to the guide member  2708 , but while not having the bevel  2840  of the access needle  2712  contact the patient’s skin. 
     While  FIG.  35 D  depicts the access needle  2712  coupling with the displacement member  2710  when the displacement member  2710  is in the proximal-most position, the access needle  2712  may be engaged with the displacement member  2710  when the displacement member is at the distal-most position or at any position between the distal-most position and the proximal-most position. When the access needle  2712  is in the proximal-most position, as shown in  FIG.  35 D , the physician may manipulate the probe and the distal member  2734  of the upper mount  2702  to manipulate the perineal skin and subcutaneous tissue of the patient. When the trajectory of the access needle  2712  is appropriately positioned relative to the patient’s perineal skin and subcutaneous tissue, the physician may distally displace the access needle  2712  by pushing on one or more of the back wall member  2798  or flanges  2796  of the displacement member  2710 , or the hub  2846  of the access needle  2712 . In certain embodiments, the displacement member  2710  may be biased or spring-loaded such that the physician may actuate a mechanism that distally advances the displacement member  2710  and the access needle  2712  without a need for manual advancement by the physician. As the access needle  2712  and the displacement member distally advance or displace, the displacement member  2712  will lock or be secured into the distal-most position via the ramps of the stop feature  2746  positioned on the top surface  2744  of the rectangular member  2728 . In the distal-most position, as seen in  FIG.  27   , the displacement member  2710  is prevented from further distal displacement via the distal member  2734 . In particular, a front edge or surface  2850  of the distal end  2772  of the displacement member  2710  abuts or is adjacent a proximal surface  2748  of the distal member  2734  when the displacement member  2710  is in the distal-most position. In certain embodiments, as seen in  FIG.  27   , the back surface  2748  may abut or be adjacent the front edge or surface  2850  of the upper members  2784 , the lower tab members  2780  (not seen in  FIG.  27   ) and/or part of the upside-down U-shaped member  2790 . 
     As further seen in  FIG.  27   , the distal members  2734  extend inward towards the needle receiving ports  2768  but may define an opening or gap between the rounded inner edges  2736  for the access needle  2712  to extend therethrough. 
     Once the access needle  2712  is in position in the patient’s skin and subcutaneous tissue, the biopsy procedure may continue, as described previously, with the physician extending a biopsy needle through the lumen  2844  of the access needle  2712  and into the patient’s prostate. Once procedure is complete, the physician may remove the access needle  2712  from the patient’s body by proximally displacing the displacement member  2710  and the access needle  2712  by pulling or pushing on the displacement member  2710  or access needle. Alternatively, the access needle  2712  may be disengaged with the displacement member  2710  while the displacement member  2710  is in the distal-most position. 
     The discussion will now focus on additional and alternative embodiments of the biopsy guide. As seen in  FIG.  36   , the displacement member  2710  may include the upper members  2784  and the lower tab members  2780  for engaging with and sliding or displacing relative to the rectangular members  2728  of the guide rails  2726 . The displacement member  2710  of  FIG.  36   , however, does not include an upside-down U-shaped member for engaging with the side members  2732  of the guide rails  2726  and, further, does not include the back wall member  2798  and the flanges  2796 . Features of both embodiments of the displacement member  2710  may be combined as needed and without limitation. 
     The lower mount  2704 , as described herein, may take many forms without departing from the scope of the present disclosure. Other mechanisms to couple the upper mount  2702  to the probe are possible and contemplated herein. For example, the upper mount  2702  may couple with or be integrally formed with a thin sheath or sleeve of latex, polyurethane, or other materials, such as a male condom. The sheath may be fitted over the probe in a tight fitting manner such that the upper mount  2702  is secured in position relative to the probe. 
     Additional or alternative embodiments of the lower mount  2704  may include rubber or rubber-type cinch straps that are coupled with or integral with the upper mount  2702 . 
     The upper mount  2702 , as described herein, may take many forms without departing from the scope of the present disclosure. Other mechanisms to guide the access needle  2712  are possible and contemplated herein. For example, the displacement member  2710  supporting the access needle  2712  may be coupled to a platform on a coupler side of a four-bar linkage (e.g., parallelogram linkage) where the fixed portion of the linkage may be coupled with the base platform  2722  of the guide member  2710 . The platform may be displaceable distal-proximal by urging the platform distally or proximally, while displacing in an arcuate path. In the case of a parallelogram linkage, the trajectory of the access needle  2712  may remain parallel to the longitudinal axes of the probe and guide member  2710  while vertically displacing. In this way, such a linkage may be used for distal-proximal displacement as well as vertical displacement or adjustment, as needed for a particular biopsy procedure. This type of displacement member  2710  may be used with the guide member  2708  as described herein with or without modification. 
     As another example, the displacement member  2710  supporting the access needle  2712  may be coupled to a carriage or lead screw nut that is displaced relative to the guide member  2708  (and probe) via rotation of a lead screw. The lead screw may be positioned parallel to the longitudinal axis of the guide member  2708  and the probe such that displacement of the lead screw nut and, thus, the displacement member  2710  and access needle  2712  displace or translate distal-proximal while maintaining a trajectory of the access needle  2712  that may be fixed. A bottom side of the lead screw nut may include a feature or protrusion that extends into a channel formed in the base platform  2722  of the guide member  2708  such that the lead screw nut does not rotate, but, rather, displaces or translates linearly distal-proximal in response to rotation of the lead screw. The lead screw may be rotatable by hand via, for example, a handle at the proximal end of the lead screw. 
     Reference is now made to  FIGS.  37 A- 37 F , which depict various views of another embodiment of the biopsy guide  3700 . As seen in  FIG.  37 A , which is a front isometric view of the biopsy guide  3700 , the guide  3700  is similar to previously described embodiments of the guide in that it includes an upper mount  3702  and a lower mount  3704 . The lower mount  3704  is adapted to secure the guide  3700  to a transrectal probe and includes the same features as the previously described embodiment. The upper mount  3702  may releasably couple with the lower mount  3704 . As seen in  FIGS.  37 B and  37 C , which are, respectively, front and back isometric exploded views of the upper mount  3702 , the biopsy guide  3700  further includes a guide member  3710  and a displacement, sliding, or translating member  3706  that is adapted to couple with an access needle  3708 . 
     As seen in  FIGS.  37 B- 37 C and  37 E- 37 F , the displacement member  3706  includes a vertically extending member  3712  having five needle receiving ports  3714  formed within the member  3712 . The ports  3714  may receive the access needle  3708  within any of the ports  3714 , as previously described, to vary the height of the access needle  3708  relative to the probe (not shown). The access needle  3708  may couple with the needle receiving ports  3714  such that they may be displaced together relative to the guide member  3710 . 
     As seen in the figures, a bottom end  3716  of the vertically extending member  3712  is coupled to a distal end  3718  of a rail member  3720  that may slidingly engage with the guide member  3710 . The rail member  3720  includes a flange member  3722  and a web member  3724  arranged in a T-beam shape. That is, the flange member  3722  is wider than the web member  3724 , which projects upward and substantially perpendicularly from a central portion of the flange member  3722 . From the distal end  3718 , the rail member  3720  extends proximally to a proximal end  3726 . At the proximal end  3726  is an end plate member  3728 , which prevents distal displacement of the displacement member  3706  past a certain point. 
     As seen in  FIGS.  37 C and  37 D , the guide member  3710  includes a rail receiving slot or channel  3730  having a proximal opening  3732 , a distal opening  3734  (seen in  FIG.  37 B ), and a top opening  3736 . The rail receiving slot  3730  is generally a negative shape of the rail member  3720  and may receive the rail member  3720  therein and permit the rail member  3720  and, thus, the displacement member  3706  and access needle  3708  to displace relative to the guide member  3710 . When the rail member  3720  is positioned within the rail receiving slot  3730 , inner surfaces  3738  of the slot  3730  may contact the flange and web members  3722 ,  3724  and restrain the displacement member  3706  from lateral displacement and vertical tilting while allowing distal-proximal displacement or translation of the displacement member  3706 . Thus, the displacement member  3706  may be displaced or translated distally and proximally while maintaining alignment of a trajectory of the access needle  3708  substantially parallel with a longitudinal axis of the probe when the biopsy guide  3700  is coupled with the probe. 
     As seen in  FIG.  37 A , the displacement member  3706  is in a distal-most position with the distal end  3718  of the rail member  3720  and a distal end  3740  of the vertically extending member  3712  being about coplanar with a distal face  3742  of a distal member  3744  of the guide rail members  3746 , which may be similar to as previously described in relation to previous embodiments. In the distal-most position, the rail member  3720  extends past the distal opening  3734  of the rail receiving slot  3730 , and the end plate member  3728  of the rail member  3720  abuts or is adjacent the proximal opening  3732  of the rail receiving slot  3730 . To proximally displace the displacement member  3706  from the distal-most position, the physician may pull or push on the end plate member  3728 , the vertically extending member  3712 , or the access needle  3708 . 
     It is noted that the guide rail members  3746  and, more particularly, the distal members  3744  may be used by the physician to manipulate the perineal skin and subcutaneous tissue of the patient, as described previously. And while the embodiment of the biopsy guide  3700  in  FIGS.  37 A- 37 F  describe a rail and slot type of arrangement between the displacement member  3706  and the guide member  3710 , other mechanisms are possible to displace the displacement member  3706  relative to the guide member  3710 . Additionally or alternatively, features and elements from other embodiments of the biopsy guide may be incorporated into the present embodiment without limitation. Similarly, features and elements from the present embodiment of the biopsy guide may be incorporated into any of the other embodiments of the biopsy guide without limitation. 
     As seen in  FIG.  37 G , which is a side view of another embodiment of the displacement member  3706  with the access needle  3708  partially positioned within the top needle receiving port  3714  of the vertically extending member  3712 , the rail member  3720  may be replaced by a lead screw  3748  and the bottom end  3716  of the vertically extending member  3712  may include a lead screw nut  3750  that rotationally engages with the lead screw  3748  to cause the displacement member  3706  and the access needle  3708  to displace or linearly translate relative to the probe and the guide member  3710  (not shown). The lead screw  3748  may be rotationally coupled with bearings  3752  at opposite ends which allow the lead screw  3748  to rotate thereon. The lead screw nut  3750  may be prevented from rotating by a guide rail  3754  that extends between the bearings  3752  and also extends through a passageway in the lead screw nut  3750 . In this way, as the lead screw  3748  rotates, the lead screw nut  3750 , as well as the vertically extending member  3712  and the access needle  3708 , are caused to displace or translate distal-proximal because the lead screw nut  3750  is prevented from rotating by the guide rail  3754 . The lead screw  3748  may include a handle  3756  for rotating the lead screw  3748 . The displacement member  3706  shown in  FIG.  37 G  may be coupled with the guide member  3710  shown in the previous figures such that the lead screw  3748  is generally parallel with the longitudinal axis of the guide member  3710  and the probe. The displacement member  3706  may, for example, couple with the base platform of the guide member  3710  at the bearings  3752 , or at other parts of the member  3706 . 
     As seen in  FIGS.  37 H- 37 I , which are, respectively, an isometric front view and a side view of another embodiment of the biopsy guide  3900 , it includes a probe coupling mechanism  3902  in the form of collars that may be adjustably secured to the probe  3904 . Four arm members  3906  are pivotally coupled at bottom ends  3908  to the probe coupling mechanism  3902  and pivotally coupled at top ends  3910  to a platform member  3912 . The arm members  3906  may be of equal length such that the platform member  3912  is capable of displacing distal-proximal while maintaining a parallel orientation relative to the probe  3904 . More particularly, as seen in  FIG.  37 I , the platform member  3912  may include a longitudinal axis that is generally parallel to a longitudinal axis of the probe  3904  in all distal-proximal orientations of the platform member  3912  relative to the probe  3904 . The platform member  3912  may include a longitudinally extending channel  3914  for receiving and guiding a displacement member  3916  having a needle receiving port  3918 . The displacement member  3916  may include a flanged lower body portion  3920  that matches a shape of the channel  3914  such that the displacement member  3916  may slide within the channel  3914  or displace relative to the platform member  3912  while maintaining an orientation of a needle positioned within the needle receiving port  3918  that is generally parallel to the longitudinal axis of the probe  3904 . 
     As seen in  FIG.  37 I , the biopsy guide  3900  may function as a four bar parallel or parallelogram linkage during displacement of the platform member  3912 . In particular,  FIG.  37 I  shows three positions of the platform member  3912  as it displaces. A first position  3922  shows the platform member  3912  at a highest position relative to the probe  3904  where the arm members  3906  are vertically extended to their maximum. A second position  3924  shows the platform member  3912  as it distally displaces while rotating clockwise and lowering the platform member  3912  relative to the probe. A third position  3926  shows the platform member  3912  as it further distally displaces while rotating clockwise and lowering the platform member  3912   relative to the probe. As seen in all positions  3922 ,  3924 ,  3926 , a longitudinal axis of the platform member  3912  may remain generally parallel with a longitudinal axis of the probe  3904 . 
     Reference is now made to  FIG.  37 J , which is a front isometric view of another embodiment of an upper mount  4000 . As seen in the figure, the upper mount  4000  includes a guide member  4002  that is similar to previously described embodiments in that it includes a pair of guide rails  4004  that extend longitudinally and are spaced apart from each other. This embodiment of the upper mount  4000 , however, does not include a displacement member. Rather, the guide mount  4002  of the upper mount  4000  of  FIG.  37 J  includes a vertically oriented member  4008  including needle receiving ports  4006  that are also vertically aligned. The member  4008  may not be displaceable relative to the guide member  4002  in this particular embodiment. 
     That is, the needle receiving ports  4006  may align a trajectory of an access needle in any of the ports  4006  such that a trajectory of the access needle may be generally parallel to a longitudinal axis of the probe. The needle receiving ports  4006  may be integrally formed with the guide member  4002 . Or, the vertical member  4008  including the needle receiving ports  4006  may be releasably coupled to the guide member. In a releasable arrangement, the vertical member  4008  may be coupled with the guide member via any coupling mechanism described herein or known in the art. As seen in the figure, the needle receiving ports  4006  are cylindrical and extend generally from a proximal end  4010  to a distal end  4012  of the guide member  4002 . The distal tip  4014  of the needle receiving ports  4006  may be about coplanar with a distal face  4016  of the distal members  4018  of the guide rails  4004 . 
     Reference is made to  FIGS.  37 K- 37 L , which are, respectively, front and side views of another embodiment of a biopsy guide  4100 . As seen in the figures, the biopsy guide  4100  includes displacement member  4102  including a vertically oriented body  4104  having five vertically aligned needle receiving ports  4106  for receiving, supporting, and orienting an access needle. At a bottom end  4108  of the vertical body  4104  is a probe coupling mechanism  4110  including a collar  4112  having a guide rail or protrusion  4114  extending from an inner surface  4116  of the collar  4112 . The guide rail  4114  extends longitudinally in the collar  4112  and may be received by a correspondingly shaped channel or slot  4120  in a transrectal probe  4118 . In this way, the displacement member  4102  may slide, displace, or translate relative to the probe  4118   while being restrained from certain movements by the interaction between the guide rail  4114  and the channel  4120 . As such, the access needle supported by the needle receiving port  4106  may displace or translate distal-proximal relative to the probe  4118  while maintaining a trajectory that is generally parallel with a longitudinal axis of the probe  4118 . 
     The inner surface  4116  may include roller bearings or similar structures to permit the collar  4112  to roll, translate, or displace relative to the probe  4118 . While the channel  4120  is described as being formed in the probe  4118 , the channel  4120  may be formed in a separate member that is coupled to the probe  4118 . In this case, a specialized probe having a channel may not be needed; rather, any off-the-shelf ultrasound probe may be used with the separate member having the channel  4120  to utilize the biopsy guide  4100  of the present embodiment. 
     Reference is made to  FIGS.  37 M- 37 U , which depict various views of alternative embodiments of the lower mount. To begin, reference is made to  FIGS.  37 M- 37 Q .  FIG.  37 M  is a front isometric view of a biopsy guide  4200 .  FIG.  37 N  is a front view of the biopsy guide  4200 .  FIG.  37 O  is a front isometric view of a cinch strap  4202 .  FIG.  37 P  is a front isometric view of a V-block insert  4204 .  FIG.  37 Q  is a front view of the biopsy guide  4200  of  FIG.  37 M  with an insert  4204  of  FIG.  37 P . 
     As seen in  FIG.  37 M , the biopsy guide  4200  includes an upper mount  4206  and a lower mount  4208 . The upper mount  4206  may include a base platform  4210  and a pair of guide rails  4212  extending longitudinally from the base platform  4210 . The guide rails  4212  may guide a displacement member (not shown), which may support an access needle (not shown), as described in previous embodiments. The lower mount  4208  may include a cinch strap  4202 , as shown in  FIG.  37   ), which may include a flange  4214  at one end  4216  and a series of transversely extending ridges  4218 . The cinch strap  4202  may be fitted or positioned within a slot  4220  in the base platform  4210  such that the flange  4214  abuts the surfaces of the slot  4220  and is prevented from extending through the slot  4220 . The cinch strap  4202  may be fitted around the transrectal probe  4222  and positioned within a locking opening  4224  opposite the slot  4220  in the base platform  4210 . The cinch strap  4202 , which may be rubber or otherwise made of a flexible material, may be pulled tightly at the free end  4226  such that the ridges  4218  are progressively locked by the locking opening  4224 . Once appropriately tightened, the upper mount  4206  is now secured to the probe  4222 . 
     As seen in  FIGS.  37 P- 37 Q , the lower mount  4208  of the biopsy guide  4200  may include a V-block insert  4204  positioned between the probe  4222  and the cinch strap  4202 . The V-block insert  4204  may include a pair of slots  4228  on opposite sides of the insert  4204  that may be sized to receive the cinch strap  4202  therethrough to secure the V-block insert  4204  into position relative to the cinch strap  4202 . The V-block insert  4204  ensures at least three points of contact between the probe and the biopsy guide  4200 : one point of contact between the probe  4222  and an underside of the base platform  4210 ; and, two points of contact between the probe  4222  and the V-block insert  4204 . 
     Reference is made to  FIGS.  37 R- 37 S , which depict, respectively, a front isometric view and a front view of another embodiment of a biopsy guide  4300 . Similar to the previously described embodiments, the biopsy guide  4300  includes an upper mount  4302  and a lower mount  4304 . The upper mount  4302  may include a base platform  4306  and a pair of guide rails  4308  extending longitudinally and spaced apart from each other. The guide rails  4308  may guide a displacement member (not shown), which may support an access needle (not shown), as described in previous embodiments. The lower mount  4304  may include a curvilinear shaped inner surface  4310  opposite the base platform  4306  and pair of opposing arms  4312  extending downward. The arms  4312  may converge on a bottom side  4314  of the lower mount  4304 . A V-block insert  4316  may be positioned an opening  4318  of the lower mount  4304 . The opening  4318  may be sized and shaped to receive the transrectal probe  4322  therein. The V-block insert  4316  may be vertically adjustable within the opening  4318  via a thumb-screw  4320 . When actuated or rotated, the thumb-screw  4320  may push the V-block insert  4316  vertically to exert a force on the probe  4322 , which, in turn, exerts a force on the inner surface  4310  of the base platform  4306  of the lower mount  4304 . 
     Reference is made to  FIGS.  37 T- 37 U , which depict, respectively, a front isometric view and a front view of another embodiment of a biopsy guide  4400 . As seen in the figures, the device  4400  includes an upper mount  4402  and a lower mount  4404 . The upper mount  4402  may include a base platform  4406  and a pair of guide rails  4408  extending longitudinally and spaced apart from each other. The guide rails  4408  may guide a displacement member (not shown), which may support an access needle (not shown), as described in previous embodiments. The lower mount  4404  couples the upper mount  4402  to the probe  4410  and may include a strap  4412  that is affixed at one side  4414  via a pair of fasteners (e.g., screws, bolts)  4416 . The strap  4412  may wrap around the probe  4410  and be secured in place via a worm gear mount  4418 . The worm gear mount  4418  may include a thumb-knob  4420  that is rotatable and extending to a threaded feature (e.g., ACME threads)  4422  that threadably engage with slots  4424  on the second end  4426  of the strap  4412 . As the thumb-knob  4420  is tightened, the thread feature  4422  advances on the slots  4424  and pulls the strap  4412  tighter on the probe  4410  (similar to a hose clamp). This embodiment may include a V-block insert (not shown). As seen in the figures, an underside  4426  of the base platform  4406  may be curvilinear to match the shape of the probe  4410 . These features among features from other embodiments may be combined as needed to modify any of the features of any of the biopsy guides described herein. 
     Reference is made to  FIGS.  37 V- 37 X , which depict additional and alternative embodiments of a lower mount  4502  of a biopsy guide  4500 . As seen in  FIG.  37 V , which is a front view of a lower mount  4502 , the upper mount  4504  may be similar to previously describe embodiments in that it includes a base platform  4506  and a pair of guide rails  4508 . The lower mount may include a pair of semi-circular arm members, clamps, or collars  4510  that are pivotally coupled together at a joint  4512  (e.g., pin). The pair of semi-circular arm members  4510  may open and close about the joint  4512  in a clam-shell type manner. Opposite the joint  4512 , the arm members  4510  are adjustably secured together via a thumb-screw  4514  that extends between a pair of flanges  4516 . Thus, turning the thumb-screw  4514  in a first direction may cause the pair of arm members  4510  to constrict against a probe (not shown) positioned within the opening  4518  between the arm members  4510 . And, turning the thumb-screw  4514  in a second direction may cause the pair of arm members  4510  to loosen against the probe positioned within the opening  4518 . 
       FIG.  37 W  depicts a front isometric view of the lower mount  4504  including a flexible spring band or biasing collar  4520  extending circumferentially and terminating in a pair of flanges or tabs  4522  that may be compressed together, relative to each other, to selectively enlarge the opening  4518 . The probe (not shown) may be positioned within the opening  4518   and the spring band  4520  may compress against the probe and cause a constant force to be exerted on the probe, allowing it to be used on probes of multiple diameters. The flat spring band  4520  may be replaced by a wire spring band (i.e., dumbbell clamp) without departing from the scope of the disclosure. 
       FIG.  37 X  depicts a front view of a lower mount  4504  having a pair of semi-circular arm members, clamps, or collars  4510  that are pivotally coupled together at a joint  4512  (e.g., pin). The pair of semi-circular arm members  4510  may open and close about the joint  4512  in a clam-shell type manner. Opposite the joint  4512 , the arm members  4510  are adjustably secured together via a snap-clip, ratchet, or clamp assembly  4524  including a lever arm handle  4526  a wire arm or loop  4528 . The lever arm handle  4526  is attached to one free end  4534  of the arm members  4510  and the wire arm  4528  is attached to the lever arm handle  4526 . The other free end  4530  of the other arm member  4510  includes a lip  4532  such that the wire arm  4528  may be fitted around the lip  4532  with the lever arm handle  4526  in an opened position. Once the wire arm  4528  is positioned within the lip  4532 , the lever arm handle  4526  may be pivoted towards the arm member  4510 , which pulls the free ends  4534 ,  4530  together to secure the arm members  4510  against the probe (not shown). To remove the probe from the lower mount  4504 , the lever arm handle  4526  may be pivoted outward away from the arm member  4510  of the free end  4534  and the arm members  4510  will expand relative to each other and release the probe. 
     As with many of the embodiments of the biopsy guide described herein, there may be a particular type of mechanical arrangement between the guide member and the displacement member that at least facilitates the displacement of the access needle along at least a portion of the length of the guide member. As discussed in relation to each of the embodiments, the mechanical arrangement may include at least one of a sliding arrangement, a lead screw, or a parallel bar linkage. And, as described with reference to the various embodiments of the biopsy guide, the guide member may operably couple with the transrectal probe via at least one of a sheath arrangement, a ratchet arrangement, a biased collar arrangement, a flexible strap arrangement, a clamping arrangement, or a clamshell collar arrangement. 
     Reference is now made to  FIGS.  38 A- 38 D , which depict, respectively, a transverse plane or slice image of a prostate  3800  and a urethra  3804 , a sagittal plane or slice image of a prostate  3800  and a urethra  3804 , a transverse plane or slice image of a prostate  3800  and a urethra  3804  with a marking device  3824  positioned within the urethra  3804 , and a sagittal plane or slice image of a prostate  3800  and a urethra  3804  with a marking device  3824  positioned within the urethra  3804 . As mentioned previously, during a prostate biopsy procedure it may important for the physician to identify the path of the urethra so that he or she can avoid puncturing the urethra with the access needle and the biopsy needle. The biopsy guides described herein may be used with various systems to locate the urethra via the transrectal probe in sagittal and axial planes. 
     As described previously, the probe or transducer provides imaging in axial and sagittal planes so as to provide real-time images of the prostate. As seen in  FIG.  38 A , which is a transverse plane showing the prostate  3800  and the probe  3802 , the urethra  3804  is shown, as well as a path  3806  of the urethra  3804 , as would be seen in a sagittal plane. As seen in  FIG.  38 B , which is a sagittal plane showing the prostate  3800  and the probe  3802 , the urethra  3804  is shown extending over the prostate  3800  and connecting with the bladder  3808 . 
     When the prostate is viewed, as seen in  FIGS.  38 A and  38 B , the physician may then position the access needle  2712  in an access site  3810  in the subcutaneous tissue  3812  of the perineum  3814 , where the access site  3810  is at a midpoint between a lateral edge of the prostate  3816  and the urethral path  3806  along a first axis and a midpoint between an anterior capsule  3818  and a posterior capsule  3820  along a second axis. The physician may guide the probe  3802  and the biopsy guide (not shown) along a sagittal plane to the target using the real-time image from the probe  3802 , and the physician may obtain one or more specimens  3822  of the prostate  3800  through the access needle  2712  being guided by the biopsy guide. 
     Identifying the urethra may be accomplished via a number of methods. First, as seen in  FIGS.  38 C- 38 D , a marking device  3824  such as, for example, a balloon catheter can be inserted into the urethra  3804  and used by the physician to locate the urethra  3804 . As seen in  FIGS.  38 C- 38 D , the marking device  3824  may include a catheter  3826  and a balloon  3828 . The balloon  3828  may be expanded in the bladder  3808  and the catheter  3826  may extend through the urethra  3804  and out of the patient’s body. The balloon  3828  and/or catheter  3826  may be visible in certain planes during the biopsy procedure and may aid in identifying the urethra  3804 . 
     Additionally or alternatively, the marking device  3824  may include markers  3830  such as physical or chemical markers that are visible in an ultrasound environment (e.g., pellets of polylactic and polyglycolic acids containing carbon dioxide, polyglycolic acid pads) along the length of the catheter  3826  so that the physician can view the path of the urethra  3804  as viewed in transverse or sagittal planes. Thus, the physician may be able to position a trajectory of the access needle  2712  to be adjacent and not intersecting with the path of the urethra as indicated by the markers  3830  on the catheter  3826 . The markers  3830  may be positioned on the catheter at certain intervals so as to provide a way to estimate the size or volume of the prostate  3800 . Additionally or alternatively, the catheter  3826  may include a contrast medium (e.g., dye) for visualization purposes and may otherwise function similarly to markers  3830  positioned on the catheter  3826 . 
     The biopsy guides and devices described herein may additionally include markers or sensors positioned on the biopsy guide or access needle such that movement of the guide or needle, or any device/material placed through the access needle, may be visualized via the markers/sensors by ultrasound equipment (e.g., probe) or other equipment using different imaging modalities (e.g., MRI, CT). In this way, for example, a marker positioned at a distal end of the access needle may provide visual guidance as to the location of the tip of the access needle relative to the boundaries of the prostate. 
     Although various representative implementations have been described above with a certain degree of particularity, those skilled in the art could make numerous alterations to the disclosed embodiments without departing from the spirit or scope of the inventive subject matter set forth in the specification. All directional references (e.g., distal, proximal, front, back, side, top, bottom, fore, aft, right, left, etc.) are only used for identification purposes to aid the reader’s understanding of the implementations, and do not create limitations, particularly as to the position, orientation, or use of the embodiments described herein unless specifically set forth in the claims. Joinder references (e.g., attached, coupled, connected, and the like) are to be construed broadly and may include intermediate members between a connection of elements and relative movement between elements. As such, joinder references do not necessarily infer that two elements are directly connected and in fixed relation to each other. 
     It is believed that the present disclosure and many of its attendant advantages will be understood by the foregoing description, and it will be apparent that various changes may be made in the form, construction and arrangement of the components without departing from the disclosed subject matter or without sacrificing all of its material advantages. The form described is merely explanatory, and it is the intention of the following claims to encompass and include such changes. 
     While the present disclosure has been described with reference to various embodiments, it will be understood that these embodiments are illustrative and that the scope of the disclosure is not limited to them. Many variations, modifications, additions, and improvements are possible. More generally, embodiments in accordance with the present disclosure have been described in the context of particular implementations. Functionality may be separated or combined in blocks differently in various embodiments of the disclosure or described with different terminology. These and other variations, modifications, additions, and improvements may fall within the scope of the disclosure as defined in the claims that follow.