Systematic prostate biopsies are more and more often becoming saturation biopsies.

The transrectal ultrasound (TRUS) prostate biopsy techniques have changed drastically over the years from the original Hodge sextant biopsy protocol. Before the end of the second millennium, several authors had already shown limitations in cancer detection with sextant biopsy and had reported high rates of false-negative biopsies. Thus, Hodge’s scheme became soon obsolete. In the last 5 yr, different prostatic schemes with 8 or 10 or 12 biopsies have been proposed as a new standard of reference, as emerging evidence suggested that taking >6 biopsies might have significantly increased the rate of cancer detection [1]. Nevertheless, prostate cancer detection is still an area currently fraught with many unanswered questions and much controversy. The optimal number of biopsies needed to identify all patients with prostate cancer at the earliest stage possible for optimal treatment, outcome, and survival is still not known. Prostate volume is one of the factors that may influence the prediction of cancer at first biopsy. There is a significant inverse relationship between the cancer detection rate and prostate volume and it has been shown that the yield of sextant biopsy decreases with increasing prostate volume. Mathematical models and computer simulation of prostatic biopsies demonstrate that it is necessary to increase the number of biopsies according to prostate volume especially in younger patients [1]. However, it is not clear how many