The Dutch humanist Erasmus (1466-1536) once said “In the country of the blind, the one-eyed man is king.” This is not true for prostate cancer’s diagnosis, which remains one of the only blind diagnostic procedures in cancer detection.
The indication for a prostate biopsy is almost always an elevated PSA or an abnormal digital rectal examination. The standard “needle in a haystack” procedure is to perform systematic 10- to 12-core biopsies without knowledge of lesion location in the prostate under transrectal ultrasound (TRUS) guidance. This approach is inefficient, detecting cancers in only 20% to 50% of cases, of which many are “indolent” and would have been better undetected. In addition, the procedure regularly misses aggressive cancers, thus ironically resulting in both overtreatment and undertreatment.1 A study conducted in 2007 on autopsy prostates by Haas et al2 confirmed that even 18-core TRUS-guided biopsies detect cancer in only 53% of prostate cancers.2 Urologists, the unchallenged doorkeepers of prostate cancer diagnosis, are not in a hurry to solve that conundrum. It took them almost a decade to replace digitally directed biopsies with TRUS-guided biopsies.3
Tombal BF, Van Nieuwenhove S, Lecouvet FE. Prostate Cancer Diagnosis Using MR/Ultrasound–Fusion Guided BiopsyEnding the “Needle in a Haystack” Conundrum?. JAMA Oncol. 2015;1(6):831–832. doi:10.1001/jamaoncol.2015.1063