Prostate biopsy practice varies widely in patient selection, route, tools and sampling scheme. ProBIOPSY used a systematic review and a three-round modified Delphi with 34 international experts, reaching consensus on 29 of 36 statement groups.
The panel endorsed biparametric as well as multiparametric MRI in the diagnostic pathway, provided image quality is adequate. It harmonised a targeted plus perilesional scheme and judged it sufficient for most local treatment planning. Additional contralateral systematic sampling is still needed for specific indications, especially selecting candidates for focal therapy.
For units moving to MRI-first pathways, this supports dropping routine systematic cores in most men while keeping them where the treatment plan depends on knowing the whole gland.
- Use MRI before biopsy; biparametric MRI is acceptable if image quality is good
- Take targeted cores plus perilesional cores around each MRI lesion
- Add contralateral systematic cores when focal therapy is being considered
- Tailor the biopsy scheme to the treatment decision it has to inform
Why it matters
It sets a standard that reduces unnecessary cores without losing information needed for treatment.
Don't overread it
This is expert consensus; specialty representation on the panel was imbalanced.
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