Avoiding Prostate Biopsy in Early Prostate Cancer Detection: From Liquid Biopsy to PSMA-PET

The role of prostate biopsy in early detection is increasingly being questioned in the era of advanced imaging. With the widespread adoption of multiparametric magnetic resonance imaging and the emergence of prostate-specific membrane antigen positron emission tomography/computed tomography, there is growing interest in whether concordant high-risk imaging findings may be sufficient to justify definitive treatment without histological confirmation, particularly given early data suggesting a high likelihood of clinically significant disease in such patients. However, equating high-probability imaging with diagnostic certainty remains problematic. Prostate biopsy continues to provide critical biological and prognostic information, including tumour grade, volume, and adverse pathological features that directly inform risk stratification and management decisions. While imaging is clearly reshaping the diagnostic pathway, it should currently be viewed as complementary rather than a substitute. In 2026, biopsy remains central to prostate cancer diagnosis, and caution is warranted before considering its omission.