Prostate cancer diagnosis: Biopsy approaches

Abstract

Prostate cancer is a common and increasing malignancy in men. Tissue is generally obtained using prostate biopsy for diagnosis and risk stratification. There are many prostate biopsy techniques. Historically, the transrectal approach has been the most adopted. In many centers, however, there has a been a shift towards transperineal prostate biopsies, increasingly performed under local anesthetic. The transperineal approach has proven advantages, including better sampling of the anterior area of the prostate and lower infection rates. Biopsies are typically performed using a combination of a systematic and targeted approach. Targeting of lesions identified by magnetic resonance imaging can be performed cognitively, assisted by a fused imaging approach with the transrectal ultrasound, or directly within the magnetic resonance imaging scanner. There are several novel developments in the field, which include robotic techniques to guide biopsy needles based on fusion images or directly targeting lesions robotically during in-bore magnetic resonance imaging.