自最初描述以来，用于检测前列腺癌（PCA）的前列腺活检技术一直在不断发展。多参数磁共振成像 (mpMRI) 已被证明具有超过 90% 的灵敏度来检测指标病变。这篇叙述性综述讨论了几种活检策略的证据，特别是在可能有资格接受局部治疗的患者的背景下。 2024 年 2 月 15 日使用在线医学文献分析和检索系统 (Medline) 进行了一项非系统文献研究， Web of Science 和 Google Scholar。即使采取了充分的抗生素预防措施，经直肠 (TR) 途径也会增加术后败血症发生率。国际指南现已推荐经会阴（TP）途径，首先是因为它可以降低尿脓毒症的发生率。最近的证据表明，与 TR 途径相比，TP 并不逊色，甚至在前部和心尖区具有临床意义的 PCA (csPCA) 检出率更高，而这些区域通常很难使用 TR 途径进行定位。多种靶向技术（认知、软件融合或内孔）增强了我们对前列腺癌侵袭性和负担提供准确风险评估的能力，同时减少了核心数量并减少了临床上不显着的前列腺癌 (ciPCA) 的数量。虽然 MRI-TB 已经证明了其作用，但系统活检 (SB) 的作用仍然很重要，因为它可以检测到 5-16% 的 csPCA，而单独使用 MRI-TB 可能会漏掉这种情况。 SB 的策略主要取决于所使用的路线（TR 与 TP）和要收集的核心数量（10-12 核心与饱和活检与经会阴模板映射活检或金斯伯格协议与区域活检）已经描述了几种活检策略，在评估患者的局部治疗时应该了解这些策略。由于 MRI 系统地低估了病变大小，因此系统活检，尤其是病灶周围活检，可以帮助提高灵敏度，但代价是增加核心数量。© 2024。作者。

Since its initial description the prostate biopsy technique for detection of prostate cancer (PCA) has constantly evolved. Multiparametric magnetic resonance imaging (mpMRI) has been proven to have a sensitivity exceeding 90% to detect the index lesion. This narrative review discusses the evidence around several biopsy strategies, especially in the context of patients that might be eligible for focal therapy.A non-systematic literature research was performed on February 15th 2024 using the Medical Literature Analysis and Retrieval System Online (Medline), Web of Science and Google Scholar.The transrectal (TR) route is associated with an increased postoperative sepsis rate, even with adequate antibiotic prophylaxis. The transperineal (TP) route is now recommended by international guidelines, firstly for its decreased rate of urosepsis. Recent evidence shows a non-inferiority of TP compared to TR route, and even a higher detection rate of clinically significant PCA (csPCA) in the anterior and apical region, that are usually difficult to target using the TR route. Several targeting techniques (cognitive, software-fusion or in-bore) enhance our ability to provide an accurate risk assessment of prostate cancer aggressiveness and burden, while reducing the number of cores and reducing the number of clinically insignificant prostate cancer (ciPCA). While MRI-TB have proven their role, the role of systematic biopsies (SB) is still important because it detects 5-16% of csPCA that would have been missed by MRI-TB alone. The strategies of SB depend mainly on the route used (TR vs. TP) and the number of cores to be collected (10-12 cores vs. saturation biopsies vs. trans-perineal template mapping-biopsies or Ginsburg Protocol vs. regional biopsies).Several biopsy strategies have been described and should be known when assessing patients for focal therapy. Because MRI systematically under evaluates the lesion size, systematic biopsies, and especially perilesional biopsies, can help to increase sensitivity at the cost of an increased number of cores.© 2024. The Author(s).