Transrectal ultrasound-guided biopsy of the prostate: development of the procedure, current clinical practice, and introduction of self-embedding as a new way of processing biopsy cores.

PURPOSE This study reviews the development of transrectal sonographically guided biopsy procedures of the prostate and optimization of the procedure in daily clinical practice. MATERIALS AND METHODS We conducted a literature review of the historic development and current practice of prostate biopsy procedures and present our systematic 12-core biopsy protocol. For processing the biopsy cores, we introduce the new technique of self-embedding. RESULTS The systematic biopsy protocols proposed in the literature can be summarized as sextant protocols, extended sextant protocols, 12-core protocols, extended 12-core protocols, and saturation biopsy protocols. The systematic 12-core prostate biopsy has become the new gold standard, replacing the classic sextant protocol. There is, however, little consensus about the biopsy procedure in the literature nor in daily practice. We propose a systematic biopsy protocol consisting of 12 cores in a fan-shaped arrangement that originates from the apex. Self-embedding of the biopsy cores is a simple new way of processing that provides additional information for the operating urologist (i.e., exact localization of the tumor and distance of the carcinoma from the capsule if a nerve-sparing procedure is planned). CONCLUSIONS A systematic 12-core prostate biopsy procedure should be used routinely. In large glands, it has proved to be useful to expand this protocol by taking additional cores. Self-embedding of the biopsy cores provides maximum information from the biopsy core distribution.