Italian Prostate Biopsies Group: 2016 Updated Guidelines Insights.
To present a summary of the updated guidelines of the Italian Prostate Biopsies Group following the best recent evidence of the literature.



A systematic review of the new data emerging from 2012-2015 was performed by a panel of 14 selected Italian experts in urology, pathology and radiology. The experts collected articles published in the English-language literature by performing a search using Medline, EMBASE and the Cochrane Library database. The articles were evaluated using a systematic weighting and grading of the level of the evidence according to the Grading of Recommendations Assessment, Development and Evaluation framework system.



An initial prostate biopsy is strongly recommended when i) prostate specific antigen (PSA) >10 ng/ml, ii) digital rectal examination is abnormal, iii) multiparametric magnetic resonance imaging (mpMRI) has a Prostate Imaging Reporting and Data System (PIRADS) ≥4, even if it is not recommended. The use of mpMRI is strongly recommended only in patients with previous negative biopsy. At least 12 cores should be taken in each patient plus targeted (fusion or cognitive) biopsies of suspicious area (at mpMRI or transrectal ultrasound). Saturation biopsies are optional in all settings. The optimal strategy for reducing infection complications is still a controversial topic and the instruments to reduce them are actually weak. The adoption of Gleason grade groups in adjunction to the Gleason score when reporting prostate biopsy results is advisable.



These updated guidelines and recommendations are intended to assist physicians and patients in the decision-making regarding when and how to perform a prostatic biopsy.
Department of Urology, Giovanni XXIII Clinic, Monastier di Treviso, Treviso, Italy.
Andrea
A
Fandella
Department of Urology, San Raffaele Hospital, Milan, Italy scattoni.vincenzo@hsr.it.
Vincenzo
V
Scattoni
Institute of Urology, Marche Polytechnic University, Riuniti Hospital, Ancona, Italy.
Andrea
A
Galosi
Department of Urology, Canizzaro Hospital, Catania, Italy.
Pietro
P
Pepe
Department of Pathology, F. Addari Institute of Oncology, S. Orsola Hospital, Bologna, Italy.
Michelangelo
M
Fiorentino
Department of Radiology, S. Orsola - Malpighi Hospital, University of Bologna, Bologna, Italy.
Caterina
C
Gaudiano
Institute of Urology, S. Orsola - Malpighi Hospital, University of Bologna, Bologna, Italy.
Marco
M
Giampaoli
Department of Urology, Hospital of Forlì, Forlì, Italy.
Roberta
R
Gunelli
Department of Urology, University of Bari, Bari, Italy.
Pasquale
P
Martino
Department of Urology, Federico II University Hospital, Naples, Italy.
Vittorino
V
Montanaro
Institute of Pathology, Marche Polytechnic University, Ancona, Italy.
Rodolfo
R
Montironi
Prostate Cancer Prevention Unit, Department of Urology, INRCA, Ancona, Italy.
Tiziana
T
Pierangeli
Department of Urology, San Raffaele Hospital, Milan, Italy.
Armando
A
Stabile
Institute of Urology, S. Orsola - Malpighi Hospital, University of Bologna, Bologna, Italy.
Alessandro
A
Bertaccini
D001706:Biopsy / Q000379:methods* / Q000592:standards*; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000473:pathology*
MRI/TRUS fusion biopsy; Prostate cancer; multiparametric MRI; prostate biopsy; review; transperineal prostate biopsy; transrectal prostate biopsy