World Journal of Urology

, Volume 37, Issue 2, pp 277–287 | Cite as

Controversies in MR targeted biopsy: alone or combined, cognitive versus software-based fusion, transrectal versus transperineal approach?

  • Giancarlo MarraEmail author
  • Guillaume Ploussard
  • Jurgen Futterer
  • Massimo Valerio
  • the EAU-YAU Prostate Cancer Working Party
Invited Review



To review the evidence addressing current controversies around prostate biopsy. Specific questions explored were (1) mpMRI targeted (TgBx) alone versus combined with systematic (SBx) biopsy; (2) cognitive versus software-based targeted biopsy; (3) transrectal or transperineal route (TP).


We performed a literature search of peer-reviewed English language articles using PubMed and the words “prostate” AND “biopsy”. Web search was implemented by manual search.


Prostate mpMRI is revolutionizing prostate cancer (PCa) diagnosis, and TgBx improves the detection of clinically significant (cs) PCa compared to SBx alone. The utility of combining SBx–TgBx is variable, but in non-expert centres the two should be combined to overcome learning curve-limitations. Whether SBx should be maintained in expert centres depends on what rate of missed cancer the urological community and patients are prone to accept; this has implications for insignificant cancer diagnosis as well. TgBx may be more precise using a software-based-approach despite cognitive TgBx proved non-inferior in some studies, and may be used for large accessible lesions. TP-biopsies are feasible in an in-office setting. Avoidance of the rectum and accessibility of virtually all prostate areas are attractive features. However, this has to be balanced with local setting and resources implications. Ongoing trials will shed light on unsolved issues.


The prostate biopsy strategy should be tailored to local expertise, needs and resources availability. Targeted biopsy enhance the ratio between cs and insignificant cancer diagnosis, although some csPCa might be missed. Software-based TgBx are likely to be more precise, especially for new users, although the additional cost might be not justified in all cases. TPBx have ideal attributes for performing TgBx and avoiding infection, although this has resources implications.


Prostate biopsy MRI Targeted biopsy Transperineal Transrectal Cognitive 



The members of the EAU-YAU Prostate Cancer Working Party: G. Ploussard, P. J. L. De Visschere, I. Tsaur, D. Tilki, P. Ost, G. Gandaglia, R. C. N. Van Den Bergh, C. Surcel, A. Kretschmer, I. Heidegger, M. Valerio, H. Borgmann, R. Mathieu.

Author contributions

Protocol/project development: GM, MV; Data collection or management: GM; Data analysis: GM, MV; Manuscript writing: GM; Manuscript editing and review for important intellectual contents: MV, GP, JF.



Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologySan Giovanni Battista Hospital, Città della Salute e della Scienza and University of TurinTurinItaly
  2. 2.Department of UrologySaint Jean Languedoc Hospital and Institut Universitaire du Cancer Toulouse OncopoleToulouseFrance
  3. 3.Department of Radiology and Nuclear MedicineRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  4. 4.Department of UrologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland

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