Prostate biopsy has made significant advancements in recent decades, not only in terms of technique and approach but also in the integration of imaging modalities and pathological assessments.

We reviewed the literature and the latest guidelines from the European and American Urological Associations to summarize the essential foundations and update the current recommendations and trends in prostate biopsy

Transperineal prostate biopsy, supported by multiparametric magnetic resonance imaging (mpMRI), has demonstrated effective detection of clinically significant prostate cancer, especially for tumors located anteriorly, while significantly reducing post-biopsy infectious complications. With the precise guidance of mpMRI, targeted biopsy, along with the complementary value of systematic biopsy and/or peri-lesion biopsy, is being increasingly adopted.

A comprehensive understanding of each biopsy technique, approach, the value of mpMRI, and appropriate adaptation to the available resources of each center are essential keys to optimizing prostate biopsy strategies