Evolving Strategies in Prostate Biopsy Sampling

Abstract

The technique of prostate biopsy has gone through continual evolution since the initial aspiration biopsies were done in the 1920s. The use of transrectal ultrasonography in the 1980s revolutionalized the technique and facilitated improved detection of prostate cancer. The initial TRUS-guided biopsies were performed in a sextant fashion. A number of studies have shown improvement in cancer detection using more cores directed in a lateral fashion, as in shown in Table 1 . A minimum of 8 cores is recommended to get adequate sampling of the prostate, while some authors recommend up to 16. Sampling of the transition zone is controversial, as there is conflicting data on whether this improves cancer detection rates ( Table 2 ). There are a number of strategies on how to perform rebiopsy on patients where suspicion of cancer is high, but biopsies have failed to reveal cancer. Finally, there are new molecular techniques that show promise in detecting prostate cancer, possibly with close to 100% accuracy with cores smaller than those used for current pathological analysis.