Abstract Aim To identify the prevalence of sepsis following trans rectal ultrasound (TRUS) biopsy of the prostate at our unit and identify potential causes for this, and to implement change to reduce the sepsis rate. Method A retrospective observational audit was performed between 01/10/19–17/01/20 for TRUS biopsy, followed by two re-audits between 05/03/20–28/05/20 and 06/08/20–17/09/2020 for trans perineal (TP) biopsy. A descriptive statistical analysis was performed on the data as well as an N-1 Chi-squared test on the data with a p<0.05 set as statistically significant. We compared our procedure to the BAUS guideline and NICE guideline for TRUS and TP biopsy. Results A total of 202 patients had TRUS biopsies between 01/10/19 to 17/01/20. 7.9% of patients presented with sepsis following their biopsy. Following our recommendation, between 05/03/20 to 28/05/20, a total of 19 patients had TP biopsy at our unit with 0 developing sepsis. A re-audit of 44 patients who underwent TP biopsy between 06/08/20 to 17/09/2020 showed no patients developing sepsis, indicating sustained improvement. Conclusion The rate of TRUS biopsy sepsis was four times higher than average levels at our department. There were zero patients who became septic following their TP biopsy. Over a 3-month period our TRUS biopsy audit showed 69 days of sepsis related admission, this is greater than £30,000 in costs. TP biopsy therefore leads to improved patient experiences with their care and also a significant cost saving to the trust.