Optimal biopsy strategies for the diagnosis and staging of prostate cancer

Prostate biopsy has evolved from a paradigm of a small number of random biopsies to one of systematic, numeric, and anatomic strategy. Over the past several years, the data have demonstrated the importance of purposeful biopsy strategies for detecting, accurately grading, and staging prostate cancer in varying patient populations. We review the optimal strategies for prostate biopsy given various clinical situations.

The 10-14 core-extended biopsy scheme is optimal for first-time prostate biopsy. In patients with clinical suspicion of prostate cancer but prior negative biopsy, saturation biopsy with a focus on lateral and apical cores may be indicated. Saturation biopsy is not indicated as an initial biopsy strategy, but is efficacious for staging patients undergoing active surveillance protocols due to the risk of pathological upgrading and clinical upstaging after initial biopsy. There remains a high discordance between prostate biopsy and radical prostatectomy Gleason scores; however, extended biopsy schemes may improve concordance rates.

Further studies are needed to define the role of extended and saturation biopsy strategies for individualized clinical situations. The goal of current prostate biopsy studies has evolved from one of purely evaluating cancer detection to investigating as to how biopsy results can assist clinical management and predict outcomes for patients with and without prostate cancer.