Techniques modernes de biopsies de prostate

The methods of prostate biopsy are constantly evolving. The conventional technique, in which sampling was randomized and systematically performed transrectally, has changed considerably. Multiparametric MRI of the prostate with gadolinium injection is now recommended in the diagnostic algorithm for patients suspected of having prostate cancer. The PI-RADS score v2.1 standardizes image acquisition and evaluation, allowing the omission of biopsies in a significant portion of patients without suspicious lesions. Biopsies are now mainly performed on suspected MRI areas. This has led to a reduction in the number of systematic biopsies, which ultimately leads to a better, more representative diagnosis of the disease.

The transrectal approach, which has been used for a long time because of its ease of use, is gradually being replaced by transperineal biopsies. These have the advantage that the risk of infection is limited as there is no contamination via the digestive tract. Moreover, the diagnostic performance of both techniques is similar, with transperineal biopsies likely having a diagnostic advantage in the apex of the prostate and in anterior localization. The development of anesthesia techniques and targeted transperineal biopsies has also enabled this procedure to be performed under local anesthesia.