A transperineal biopsy guide for use with a tubular structure and a transrectal probe. The tubular structure is sized to receive a biopsy instrument therethrough. The transrectal probe including a longitudinal axis and configured to provide imaging in a sagittal plane of the transrectal probe. The transperineal biopsy guide includes a mount attachable to the transrectal probe, and an opening above the mount and pivotable relative to the mount about an axis perpendicular to the longitudinal axis of the transrectal probe when the mount is attached to the transrectal probe. When the tubular structure is received by the opening and the mount is attached to the transrectal probe, the tubular structure can be pivoted in the sagittal plane of the transrectal probe via pivoting of the opening relative to the mount.