[Is prostate biopsy necessary before radical prostatectomy? New concept and clinical practice]

The current diagnosis and treatment concept of prostate cancer is that if prostate cancer is suspected through one or more examination methods, prostate biopsy should be performed to confirm the diagnosis of prostate cancer and then subsequent treatment should be given. Nowadays, the application of multi-parameter magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen (PSMA) PET/CT has further improved the imaging diagnosis of prostate cancer, and the diagnostic accuracy of clinically significant prostate cancer has reached almost 100%. In addition, minimally invasive techniques represented by robot-assisted laparoscopic surgery have developed rapidly, and the safety and postoperative recovery of radical prostatectomy have been significantly improved. Therefore, we proposed the concept of radical prostatectomy avoiding biopsy (RPAB), that is, the patients with high suspicion of prostate cancer by multi-parameter MRI and PSMA PET/CT can be directly treated by radical surgery. Preliminary clinical practice confirmed that this concept is feasible. However, RPAB is not suitable for all prostate cancer patients, and any new concept needs to be supported by long-term and high-quality clinical studies. We predict that RPAB will become a new clinical option and produce good economic and social benefits.