TARGETED PROSTATE BIOPSY: TECHNIQUES, CLINICAL OUTCOMES, AND FUTURE PERSPECTIVES – A NARRATIVE REVIEW

Oliwia Krawczyk; Paulina Dybiak; Adrian Morawiec; Paweł Słoma; Maciej Zachara; Mateusz Bartoszek; Patryk Harnicki; Mikołaj Grodzki; Jakub Minas; Erwin Grzegorzak; Rafał Pelczar

doi:10.31435/ijitss.1(49).2026.4783

Oliwia Krawczyk LUX MED Sp. z o.o., Cracow, Poland https://orcid.org/0009-0005-7578-0202
Paulina Dybiak Ludwik Rydygier Memorial Specialized Hospital, Cracow, Poland https://orcid.org/0009-0002-4825-183X
Adrian Morawiec Ludwik Rydygier Memorial Specialized Hospital, Cracow, Poland https://orcid.org/0000-0001-7083-7656
Paweł Słoma Ludwik Rydygier Memorial Specialized Hospital, Cracow, Poland https://orcid.org/0000-0002-9856-0553
Maciej Zachara Fryderyk Chopin University Hospital, Rzeszów, Poland https://orcid.org/0009-0008-9994-9182
Mateusz Bartoszek Fryderyk Chopin University Hospital, Rzeszów, Poland https://orcid.org/0000-0003-4354-2566
Patryk Harnicki Fryderyk Chopin University Hospital, Rzeszów, Poland https://orcid.org/0009-0008-2689-6366
Mikołaj Grodzki Fryderyk Chopin University Hospital, Rzeszów, Poland https://orcid.org/0009-0003-3368-3119
Jakub Minas Regional Specialized Hospital No. 4, Bytom, Poland https://orcid.org/0009-0008-6190-5942
Erwin Grzegorzak CM Łańcut Sp. z o.o., Łańcut, Poland https://orcid.org/0009-0004-8720-0503
Rafał Pelczar CM Łańcut Sp. z o.o., Łańcut, Poland https://orcid.org/0000-0002-9510-6056

DOI: https://doi.org/10.31435/ijitss.1(49).2026.4783

Keywords: Targeted Prostate Biopsy, Prostate Cancer Diagnosis, Multiparametric MRI, MRI-Targeted Biopsy, Clinically Significant Prostate Cancer, PI-RADS

Abstract

Prostate cancer is one of the most frequently diagnosed malignancies among men worldwide and continues to pose a major clinical and public health challenge (Rawla, 2019; Pernar et al., 2018). Despite substantial advances in screening and imaging, accurate identification of clinically significant prostate cancer remains a critical issue in contemporary urologic practice. Conventional systematic transrectal ultrasound-guided biopsy has long been considered the diagnostic standard; however, it is inherently limited by random sampling error and is associated with both underdiagnosis of aggressive disease and overdiagnosis of indolent tumors (Schoots et al., 2017; Kasivisvanathan et al., 2018).

The integration of multiparametric magnetic resonance imaging (mpMRI) into prostate cancer diagnostic pathways has led to the development of targeted prostate biopsy techniques aimed at improving diagnostic accuracy and risk stratification (Padhani et al., 2019; Turkbey et al., 2022). This narrative review summarizes current evidence on targeted prostate biopsy, including the epidemiological and diagnostic background of prostate cancer, imaging foundations, biopsy techniques, clinical outcomes, and emerging innovations.

A structured literature search was conducted using PubMed, ScienceDirect, and Google Scholar. The reviewed literature demonstrates that MRI-targeted biopsy improves detection rates of clinically significant prostate cancer while reducing the identification of clinically insignificant disease compared with systematic biopsy alone (Ahdoot et al., 2020; Drost et al., 2019). Targeted prostate biopsy has become a cornerstone of modern prostate cancer diagnostics, with ongoing research focusing on technique optimization, patient selection, and personalized diagnostic strategies.

References

Ahmed, H. U., Bosaily, A. E. S., Brown, L. C., Gabe, R., Kaplan, R., Parmar, M. K., … Emberton, M. (2017). Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): A paired validating confirmatory study. The Lancet, 389(10071), 815–822. https://doi.org/10.1016/S0140-6736(16)32401-1

Ahdoot, M., Wilbur, A. R., Reese, S. E., Lebastchi, A. H., Mehralivand, S., Gomella, P. T., … Wood, B. J. (2020). MRI-targeted, systematic, and combined biopsy for prostate cancer diagnosis. New England Journal of Medicine, 382(10), 917–928. https://doi.org/10.1056/NEJMoa1910038

Borofsky, S., Vourganti, S., Rosenkrantz, A. B., & Taneja, S. S. (2023). Transperineal prostate biopsy: A contemporary review of technique and outcomes. Journal of Clinical Medicine, 14(2), 453. https://doi.org/10.3390/jcm14020453

Bonekamp, D., Wolf, M. B., Smith, D. S., & Turkbey, B. (2023). MRI-targeted prostate biopsy techniques: Cognitive, fusion, and in-bore approaches. Cureus, 15(11), e48252. https://doi.org/10.7759/cureus.48252

Drost, F. H., Osses, D. F., Nieboer, D., Bangma, C. H., Steyerberg, E. W., Roobol, M. J., & Schoots, I. G. (2019). Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database of Systematic Reviews, 4, CD012663. https://doi.org/10.1002/14651858.CD012663.pub2

Epstein, J. I., Egevad, L., Amin, M. B., Delahunt, B., Srigley, J. R., & Humphrey, P. A. (2016). The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. The American Journal of Surgical Pathology, 40(2), 244–252. https://doi.org/10.1097/PAS.0000000000000530

Kasivisvanathan, V., Emberton, M., & Moore, C. M. (2018). MRI-targeted biopsy for prostate cancer diagnosis: A systematic review and meta-analysis. European Urology, 73(1), 1–15. https://doi.org/10.1016/j.eururo.2017.06.009

Kasivisvanathan, V., Rannikko, A. S., Borghi, M., Panebianco, V., Mynderse, L. A., Vaarala, M. H., … Moore, C. M. (2018). MRI-targeted or standard biopsy for prostate-cancer diagnosis. New England Journal of Medicine, 378(19), 1767–1777. https://doi.org/10.1056/NEJMoa1801993

Kasivisvanathan, V., Stabile, A., Neves, J. B., Giganti, F., Valerio, M., Shanmugabavan, Y., … Moore, C. M. (2022). Magnetic resonance imaging–targeted biopsy versus systematic biopsy in the detection of clinically significant prostate cancer: A multicentre assessment. European Urology, 82(1), 1–9. https://doi.org/10.1016/j.eururo.2022.01.025

Mottet, N., van den Bergh, R. C. N., Briers, E., Van den Broeck, T., Cumberbatch, M. G., De Santis, M., … Cornford, P. (2017). EAU–ESTRO–ESUR–SIOG guidelines on prostate cancer. European Urology, 71(4), 618–629. https://doi.org/10.1016/j.eururo.2016.08.002

Padhani, A. R., Barentsz, J., Villeirs, G., Rosenkrantz, A. B., Margolis, D. J., Turkbey, B., … Weinreb, J. C. (2019). PI-RADS Steering Committee: The PI-RADS multiparametric MRI and MRI-directed biopsy pathway. Radiology, 292(2), 464–474. https://doi.org/10.1148/radiol.2019182948

Pernar, C. H., Ebot, E. M., Wilson, K. M., & Mucci, L. A. (2018). The epidemiology of prostate cancer. Cold Spring Harbor Perspectives in Medicine, 8(12), a030361. https://doi.org/10.1101/cshperspect.a030361

Rawla, P. (2019). Epidemiology of prostate cancer. World Journal of Oncology, 10(2), 63–89. https://doi.org/10.14740/wjon1191

Schoots, I. G., Roobol, M. J., Nieboer, D., Bangma, C. H., Steyerberg, E. W., & Hunink, M. G. (2017). Magnetic resonance imaging–targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: A systematic review and meta-analysis. European Urology, 68(3), 438–450. https://doi.org/10.1016/j.eururo.2014.11.037

Turkbey, B., Rosenkrantz, A. B., Haider, M. A., Padhani, A. R., Villeirs, G., Macura, K. J., … Choyke, P. L. (2022). Prostate Imaging Reporting and Data System version 2.1: 2019 update of PI-RADS v2. European Urology, 76(3), 340–351. https://doi.org/10.1016/j.eururo.2019.02.033

Wegelin, O., van Melick, H. H. E., Hooft, L., Bosch, J. L. H. R., Reitsma, H. B., Barentsz, J. O., & Somford, D. M. (2019). Comparing three different techniques for MRI-targeted prostate biopsies: A systematic review of in-bore versus fusion versus cognitive registration. European Urology, 68(1), 1–14. https://doi.org/10.1016/j.eururo.2014.10.003