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Prostate biopsy - current discussions and future perspectives

Prostate Cancer and Prostatic Diseases (2026) Cite this article

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In 1989, Hodge et al. demonstrated the superiority of a transrectal (TR) sextant-based biopsy strategy over targeted sampling from sonographically suspicious areas [1], establishing the gold standard of systematic sampling for the next three decades.

This clinical practice was changed by the PROMIS trial indicating the superiority of multiparametric MRI (mpMRI) versus 12-core systematic sampling in the detection of significant prostate cancer (sPC) and the PRECISION trial showing non-inferiority of MRI-targeted biopsy versus 12-core systematic biopsy [2, 3]. Despite these advances, there is still an unresolved challenge of “balancing diagnostic accuracy for timely sPC detection with the burden on individuals and healthcare providers” [4].

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Author information

Authors and Affiliations

  1. Department of Urology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    August Sigle & Christian Gratzke

  2. Department of Molecular Medicine and Surgery (Solna), Karolinska Institutet, Stockholm, Sweden

    August Sigle

  3. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy

    Giorgio Gandaglia

  4. Vita-Salute San Raffaele University, Milan, Italy

    Giorgio Gandaglia

  5. Division of Surgery and Interventional Science, University College London, London, UK

    Veeru Kasivisvanathan

  6. Department of Surgical Sciences, Division of Urology, Città della Salute e della Scienza University of Turin, Turin, Italy

    Giancarlo Marra

  7. Division of Urology, Department of Surgical Sciences, Molinette Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy

    Marra Giancarlo

  8. Division of Urology, IRCCS Azienda OSpedaliero Universitaria di Bologna, Bologna, Italy

    Bianchi Lorenzo

  9. IRCCS Ospedale Policlinico San Martino, Genova, Italy

    Bauckneht Matteo

  10. Department of Health Sciences (DISSAL), University of Genova, Genova, Italy

    Bauckneht Matteo

  11. Department of Urology, Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy

    Gandaglia Giorgio

  12. Department of Urology, University of Cincinnati, Cincinnati College of Medicine, Cincinnati, OH, USA

    Martini Alberto

  13. Department of Precision Medicine in the Medical, Surgical and Critical Care Area (Me.Pre.C.C.), University of Palermo, Palermo, Italy

    Nicoletti Rossella

  14. Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy

    Nicoletti Rossella

  15. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Rajwa Pawel

  16. Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan

    Rajwa Pawel

  17. Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland

    Rajwa Pawel

  18. Department of Urology, Institut Mutualiste Montsouris, Paris, France

    Rodriguez Sanchez Lara

  19. Department of Urology, St. Antonius Hospital, Utrecht, Netherlands

    Scheltema Matthijs

  20. St. Vincent’s Prostate Cancer Centre, Sydney, Australia

    Scheltema Matthijs

  21. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

    Soeterik Timo

  22. Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy

    Zattoni Fabio

Authors
  1. August Sigle
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  2. Giorgio Gandaglia
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  3. Veeru Kasivisvanathan
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  4. Christian Gratzke
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  5. Giancarlo Marra
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Consortia

and the YAU Prostate Cancer Group

  • Marra Giancarlo
  • , Bianchi Lorenzo
  • , Bauckneht Matteo
  • , Gandaglia Giorgio
  • , Martini Alberto
  • , Nicoletti Rossella
  • , Rajwa Pawel
  • , Rodriguez Sanchez Lara
  • , Scheltema Matthijs
  • , Soeterik Timo
  •  & Zattoni Fabio

Contributions

AS performed the literature review, drafted the manuscript, and coordinated the overall preparation of the article. AS, GG, VK, CG, and GM contributed to the conceptualization of the manuscript and the interpretation of the literature. All authors critically revised the manuscript for important intellectual content and approved the final version.

Corresponding author

Correspondence to August Sigle.

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The authors declare no competing interests.

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Sigle, A., Gandaglia, G., Kasivisvanathan, V. et al. Prostate biopsy - current discussions and future perspectives. Prostate Cancer Prostatic Dis (2026). https://doi.org/10.1038/s41391-026-01109-4

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