The advent of prostate specific antigen (PSA) screening and transrectal ultrasonography (TRUS) has had a significant impact on the detection of prostate cancer over the last 15 years. The mean age at diagnosis has decreased and the most common stage at diagnosis is now localized disease. TRUS guidance, spring-loaded biopsy needles, utilization of oral antibiotic prophylaxis, developments in local anesthesia, increases in the number of cores sampled and the use of site-specific containers have all made the prostate biopsy easier to perform and more accurate. The indications for an initial prostate biopsy have been strongly influenced by digital rectal examinations (DREs), PSA levels and the PSA-related parameters of velocity, density, and percent free. These parameters, along with abnormal histology, also dictate the need for a repeat biopsy. With the better, earlier, and more patient-friendly usage of the prostate biopsy, there has been a decrease in the mortality rate of prostate cancer.
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