Prostate biopsy: pros and cons of the different techniques
Type:Educational Electronic Presentation
Authors: Diogo Correia Baptista, Sofia Frade Santos, José Venâncio
Educational objective

To describe the different prostate biopsy techniques and summarize their advantages and disadvantages.

Topic Review

Prostate cancer is the most common cancer and the second-highest cause of death in the male population.

Prostate biopsy is the cornerstone of prostate cancer diagnosis. Tissue biopsy samples can be obtained using either transrectal ultrasound-guided biopsy (TRUS-guided biopsy) or transperineal prostate biopsy.

Historically, the standard systematic TRUS biopsy has been widely used. However, ultrasound guiding is criticized for its low sensitivity in the detection of suspicious lesions. This fact results in a possible overdetection of indolent tumors and an underdetection of clinically significant cancers.

Another approach that allows for standardized sampling is the transperineal template-guided mapping biopsy.

Multiparametric magnetic resonance imaging (mpMRI) has revolutionized the diagnostic pathway in prostate cancer as it enables non-invasive... more

Fig. 1A: Cross-sectional image of prostate gland identifying a hypoechogenic and well delimited nodule located in the peripheral region of the right base, measuring 10 mm.
Fig. 1B: Sagittal section of the same region showing the biopsy needle within the previously described nodule. Histological analysis revealed acinar adenocarcinoma.


The optimal test for prostate cancer would be minimally invasive, have few side effects, identify the clinically relevant cancers and minimize the identification of clinically insignificant cancers.

Conventional ultrasound-guided prostate biopsies overdetect clinically insignificant cancer leading to possible overtreatment and underdetection of clinically significant cancer that may lead to death. Random TRUS-guided biopsy is still the standard of care for prostate cancer diagnosis, but there is increasing awareness of its limitations and the value of targeted prostate biopsy using more advanced imaging techniques like MRI.

Considering the high cancer detection rate of transperineal template-guided mapping biopsy, its use in a primary biopsy setting needs to be discussed. The cost–benefit ratio of the procedure could be a limitation.

In cases of suspected... more