Prostate biopsy: how many cores are enough?

Systematic prostate biopsy has revolutionized our ability to detect prostate cancer. Sextant biopsies were the mainstay of cancer detection since their inception in 1989. Over the past several years more extensive systematic prostate sampling has been introduced and has demonstrated an improved ability to detect prostate cancer. The optimal prostate biopsy scheme should be easy to perform, be able to be done in the clinic without intravenous sedation or general anesthetic, provide a high sensitivity for cancer detection, and have a low complication rate. We review several studies evaluating various biopsy schemes for both initial and repeat biopsy patients and propose an optimal biopsy scheme.