title: Repeated biopsy in the detection of prostate cancer: when and how many cores.
abstract: OBJECTIVE
  We performed an analysis of the literature about the optimal prostate biopsy (PBX) scheme in the repeated setting
  
  
  METHODS
  We performed a clinical and critical literature review by searching Medline Database from January 2005 up to January 2014. Electronic searches were limited to the English language. The keywords were: prostate cancer, prostate biopsy, transrectal ultrasound, transperineal prostate biopsy.
  
  
  RESULTS
  The recommended approach in repeated setting is still the extended scheme (EPBx) (12 cores). An approach with more than 12 cores according to the clinical characteristics of the patients may optimize cancer detection. Saturation PBx (> 20 cores) clearly improves cancer detection if clinical suspicion persists after previous negative biopsy. Nevertheless international guidelines do not strongly recommended SPBx in all situations of repeated setting. EPBx or SPBX may be, in the future, substituted by multiparametric MRI-targeted biopsies.
  
  
  CONCLUSIONS
  Since the scenario in which a PBx is changing, the issue about the number and location of the cores in PBx is still a matter of debate in repeated setting. At present, EPBx are still the gold standard even if SPBx seems to be necessary in many cases. However, random PBx does not represent the approach of the future, but rather imaging targeted biopsy.
authors: Department of Urology, University Vita-Salute, Scientific Institute San Raffaele, Milan. scattoni.vincenzo@hsr.it.
authors: Vincenzo
authors: V
authors: Scattoni
authors: Andrea
authors: A
authors: Russo
authors: Ettore
authors: E
authors: Di Trapani
authors: Umberto
authors: U
authors: Capitanio
authors: Giovanni
authors: G
authors: La Croce
authors: Francesco
authors: F
authors: Montorsi
mesh_terms: D001706:Biopsy / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*