Prostate biopsy schemes and the detection of prostate cancer.

The widespread use of digital rectal examination (DRE) coupled with measurement of prostate-specific antigen (PSA) for prostate cancer screening has led to a dramatic increase in the number of men undergoing prostate biopsy guided by transrectal ultrasound (TRUS). Systematic parasagittal sextant biopsies have been widely adopted as the standard protocol for prostate biopsy. Significant numbers of men undergo repeat biopsy because of clinical indications (abnormal DRE, elevated PSA) or atypical findings on the initial biopsy. Increases in biopsy number and changes in distribution have recently been proposed in attempts to improve the diagnostic yield of initial biopsy.