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Review
. 2025 Mar 30;14(3):831-840.
doi: 10.21037/tau-24-619. Epub 2025 Mar 26.

Personalized prostate biopsy protocols: enhancing cancer detection through tailored approaches-a narrative review

Shanqi Guo  1 , Xingkang Jiang  2
Affiliations
Review

Personalized prostate biopsy protocols: enhancing cancer detection through tailored approaches-a narrative review

Shanqi Guo et al. Transl Androl Urol. .

Abstract

Background and objective: Traditionally, patients with positive magnetic resonance imaging (MRI) results [i.e., Prostate Imaging-Reporting and Data System (PI-RADS) ≥3] would have to undergo both targeted and systematic biopsies. The 2024 European Urology Association guidelines now recommend incorporating perilesional sampling with targeted biopsy; however, these recommendations have not yet been widely adopted. This review aims to examine recent advancements in personalized prostate biopsy techniques to enhance cancer detection through tailored approaches.

Methods: We conducted a narrative review to highlight recent advancements in personalized prostate biopsy techniques, emphasizing the roles of serum prostate-specific antigen (PSA) levels, prostate volume (PV), PSA density (PSAD), region of interest (ROI), and PI-RADS scores.

Key content and findings: This review discusses personalized prostate biopsy protocols, integrating PSA levels, PV, PSAD, and PI-RADS scores. Tumor localization can be refined using transrectal or transperineal approaches. For patients with lower PSA levels (4-19.99 ng/mL), smaller PSAD (<0.1 ng/mL/cc), or PI-RADS 3 lesions, a targeted plus systematic biopsy or regional saturation biopsy may be appropriate. For those with medium PSA levels (20-50 ng/mL), PSAD (0.1-0.2 ng/mL/cc), or PI-RADS 4 lesions, regional saturation biopsy is preferred. Targeted biopsy is recommended for higher PSA levels (>50 ng/mL), PSAD (>0.2 ng/mL/cc), or PI-RADS 5 lesions. Variability in cut-off values across studies precludes meta-analysis, limiting our work to a systematic review.

Conclusions: Personalized prostate biopsy protocols considering PSA levels, PV, PSAD, ROI, and PI-RADS scores can improve prostate cancer detection accuracy. Further research and clinical validation are needed to optimize these personalized methods.

Keywords: Prostatic neoplasms; perilesional biopsy; regional saturation biopsy; systematic biopsy; targeted biopsy.

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Conflict of interest statement

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-24-619/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Tailoring prostate biopsies: unleashing precision with personalized approaches. PSA, prostate specific antigen.
Figure 2
Figure 2
Personalized prostate biopsy workflow that takes into account various factors, including serum PSA levels, PSAD, ROI, and PI-RADS score. ipSB, ipsilateral systematic biopsy; mpMRI, multiparametric magnetic resonance imaging; PSA, prostate specific antigen; PSAD, PSA density; PI-RADS, Prostate Imaging Reporting and Data System; RSB, regional saturation biopsy; ROI, region of interest; SB, systematic biopsy; TB, targeted biopsy.
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