Current Techniques of Prostate Biopsy

An Update From Past to Present

Mohamed Essam Noureldin; Martin J. Connor; Nicholas Boxall; Saiful Miah; Taimur Shah; Jochen Walz


Transl Androl Urol. 2020;9(3):1510-1517. 

In This Article

Abstract and Introduction


Knowing the demerits of the transrectal ultrasound guided biopsy has led to a shift in the general techniques and technology of the prostate biopsy. In addition, the advances in magnetic resonance imaging (MRI) sensitivity and the evidence from the PROMIS trial about its ability to detect clinically significant tumours encourage urologists and industry to implement MRI-guided targeted biopsy. However, the science is still looking how to improve safety and increase its cancer detection rate (CDR).


Prostate biopsy has undergone a recent diagnostic revolution driven by technological advances in magnetic resonance imaging (MRI) and standardised image reporting systems (i.e., PI-RADS). This, crucially, has been underpinned by high-level clinical trial evidence.[1,2] For over two decades the urological community made little progress beyond the use of conventional transrectal ultrasound guided prostate biopsy (TRUS-GB).

However, Ahmed and colleagues' landmark PROMIS trial demonstrated the limited accuracy of conventional TRUS-GB in detecting clinically significant prostate cancer (csPCa), whilst simultaneously validating the benefits of pre-biopsy multi-parametric MRI (mpMRI). Following this, the PRECISION randomised controlled study confirmed the accuracy of multiparametric MRI (mpMRI) targeted prostate biopsy by improving detection of clinically significant (Gleason ≥3+4) and reduced clinically non-significant prostate cancer detection rates (CDRs) when compared to TRUS-GB alone.

Such landmark studies have led to fervent academic interest in the utility of novel image-fusion technology, the role of transperineal prostate biopsy and in image-based prostate cancer diagnostic pathway design (Figure 1).

Figure 1.

Evolution of prostate biopsy knowledge following introduction of transrectal ultrasound guided biopsy.

Our review aims to provide an update on current techniques utilized in prostate biopsy with respect to pre-biopsy imaging, image-fusion and anatomical approach. In addition, we set to identify outstanding research questions and registered clinical trials in this rapidly evolving field.