Prostate Cancer Biopsy: Strategies

Abstract

Prostate biopsy is the gold standard for the diagnosis of prostate cancer since many decades. Technical and material advances lead to a 10- to 12-core systematic biopsy as the state of the art to detect prostate cancer in case of an elevated PSA level or suspect digital rectal examination. Since prostate imaging modalities enable visualization of potentially malignant areas, biopsy paradigm started to change in favor of targeted biopsies for optimization of cancer detection. The implementation of the multiparametric magnetic resonance imaging (mpMRI) is now known to increase detection of clinically significant cancer, improve early risk stratification, and advise patients to an adequate therapy. A variety of different fusion techniques and biopsy platforms have been developed, showing not only diagnostic but also therapeutic relevance with great future potential by integrating biopsy and focal therapy. However, there is still a debate on the right indication to use systematic, targeted, or saturation biopsies and how to perform them. Biopsy strategies should pursue the following aims: accurate detection of clinically significant cancer, reduction of overdetection of insignificant cancer, high negative predictive value, immaculate risk assessment according to the final pathology in prostatectomy specimens, low morbidity, and clinical applicability.