Prostate biopsy strategies

Early detection is critical to good management of prostate cancer patients. Markers for detection, such as prostate specific antigen (PSA), and prostate biopsy are paramount for establishing an efficient diagnosis. Patients having an initial biopsy should undergo an extended biopsy scheme incorporating at least 10-12 cores, while in those undergoing a repeat biopsy particular attention should be addressed to the anterior apex. Saturation biopsies should be considered for patients with several prior negative biopsies. The chance of finding cancer on repeat biopsies has diminished in patients harboring high-grade prostatic intraepithelial neoplasia but not in those with atypical small acinar proliferation. This article reviews the history of prostate biopsy strategies with particular attention paid towards the development of extended biopsy schemes. Furthermore, a strategy is recommended for initial and repeat biopsy patients.