ProBIOPSY: a multidisciplinary international consensus on standards for prostate biopsy

Abstract

Prostate biopsy is a complex, multi-step procedure lacking standardisation across patient selection, tools, technique, and biopsy strategy, potentially influencing local treatment planning. An international consensus project was initiated to harmonise these aspects. Methods and analysis A systematic review informed statement development. A modified Delphi process involving 34 international experts was conducted over three rounds. Panellists evaluated 96, 99, and 112 statements in Rounds 1–3, respectively, grouped into 36 stems. Statements were iteratively revised based on feedback and discussion. Consensus was assessed using a modified RAND appropriateness method. Key findings and limitations All experts completed the three rounds. Consensus was achieved for 29 of 36 stems (81%). Both biparametric and multiparametric magnetic resonance imaging were endorsed within the diagnostic pathway, provided imaging quality is adequate. Key elements of a targeted plus perilesional biopsy scheme were harmonised. For treatment planning, a targeted ± perilesional biopsy scheme was considered sufficient for most aspects of local treatment planning. However, additional contralateral sampling still seems necessary for specific indications, notably focal therapy candidate selection. Limitations include imbalances in specialty representation and heterogeneity in expertise across topics. Conclusion and clinical implications The ProBIOPSY consensus defines a contemporary, standardised framework for prostate biopsy. While targeted-based strategies are sufficient for most clinical scenarios, no single biopsy approach provides complete information for all treatment decisions, underscoring the need for indication-specific biopsy tailoring.