Optimising prostate biopsies and imaging for the future-a review.

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Transrectal ultrasound guided prostate biopsy (TRUS-Bx) is a conventional method for prostate cancer diagnosis.
• TRUS-Bx has limitations, including missing up to 18% of clinically significant prostate cancer (csPCa) and a sepsis risk of 2.4%.
• Transperineal prostate biopsy (TP-Bx) has emerged as an alternative technique.

Purpose of the Study:

• To review current prostate biopsy techniques.
• To provide an update on advanced prostate imaging modalities.
• To highlight the role of prostate-specific membrane antigen-positron emission tomography (PSMA-PET) in prostate cancer detection.

Main Methods:

• Narrative review of existing literature on prostate biopsy and imaging.
• Discussion of the evolution from TRUS-Bx to TP-Bx.
• Focus on the diagnostic capabilities of multiparametric MRI (mpMRI) and PSMA-PET.

Main Results:

• TRUS-Bx can miss clinically significant prostate cancer.
• mpMRI aids in visualizing suspicious areas, potentially avoiding unnecessary biopsies.
• PSMA-PET shows high promise for primary diagnosis and detecting metastatic lesions with greater accuracy than conventional imaging.

Conclusions:

• TP-Bx offers an alternative to TRUS-Bx, addressing some of its limitations.
• Advanced imaging, particularly PSMA-PET, is revolutionizing prostate cancer diagnostics.
• These advancements aim to improve the accuracy and efficiency of prostate cancer detection and management.