title: Detection and diagnosis of prostate cancer: what's new.
abstract: OBJECTIVE
  Prior the widespread use of PSA screening in asymptomatic men, prostate cancer was historically detected by a simple digital rectal examination. Although the gold standard for prostate cancer still remains prostate biopsy, current researches in the area of detection and diagnosis of prostate carcinoma are focusing on identification of better sampling protocols, biologic markers and imaging strategies in order to detect disease at an earlier stage. We reviewed all the recent literature on the detection of clinically meaningful prostate cancer.
  
  
  METHODS
  A systematic review of the literature using Medline up to 2005 was performed. Electronic searches were limited to the English language using the keywords prostate cancer, diagnosis, transrectal ultrasound, prostate biopsy. Unpublished information known by the authors and that were considered of interest to the readers were also included.
  
  
  RESULTS
  The prostate biopsy technique has extremely changed from the original Hodge's sextant biopsy protocol. Several authors have already reported high rates of false negative biopsy using sextant protocols. The optimal protocol should, nowadays, include six standard sextant biopsies with additional biopsies weighted more laterally (anterior horn) and medially to the apex. Repeat biopsies should also be based on an extended scheme and should include the transition zone especially in patient with at initial negative biopsy. To increase accuracy of prostatic biopsy and reduce unnecessary prostate biopsy, TRUS, power Doppler imaging (PDI), colour Doppler TRUS (CDUS), and 3-dimensional Doppler (3DD) can be successfully adopted, but their routine use is still controversial. Several types of local anaesthesia are now available and can be safely performed to reduce the pain of multi-sites biopsy protocol.
  
  
  CONCLUSIONS
  Extended biopsy schemes should be performed not only at first biopsy but especially at repeated biopsy for premalignancy lesions. The widespread use of local anesthesia makes the procedure more comfortable.
authors.affiliation: Department of Urology, University Vita-Salute, Scientific Institute H San Raffaele, Milan, Italy. scattoni.vincenzo@hsr.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scattoni
authors.forename: Mattia
authors.initials: M
authors.lastname: Sangalli
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Marco
authors.initials: M
authors.lastname: Raber
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallina
authors.forename: Fabio
authors.initials: F
authors.lastname: Fabbri
authors.forename: Antonio
authors.initials: A
authors.lastname: Saccà
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
mesh_terms: D001706:Biopsy / Q000379:methods; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000175:diagnosis*