Update on prostate biopsy technique

PURPOSE OF REVIEW: Over the past decade, a considerable number of modifications have been made to the techniques for prostate cancer biopsy. In this review, we discuss the developments reported in the literature since January 2003. RECENT FINDINGS: The addition of laterally directed biopsies has enhanced the diagnostic performance of the conventional sextant biopsy approach. Several models of the extended biopsy technique have been introduced that increase the number of cores by combining sextant and lateral biopsies to enhance the cancer detection rate. Several reports have shown that the cancer detection rate decreases as prostate volume increases, compared with an increasing cancer detection rate on repeat biopsy in men with large prostate gland volumes. Other studies have shown that the percentage of positive cores and the total percentage of tumor found at biopsy are significant independent predictors of pathological outcome on multivariate analysis. In randomized, double-blind studies, infiltration of the neurovascular bundles with lidocaine significantly reduces pain associated with extended biopsies. SUMMARY: Current reports have suggested that: (1) extended biopsy schemes decrease the false-negative rate compared with conventional sextant biopsy; (2) laterally directed biopsies from the anterior horn should be included in extended biopsy protocols; and (3) local anesthesia reduces pain associated with extended biopsy.