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.
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.
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.
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.
European urology. 2026 Jul 08 [Epub ahead of print]
Daria Chernysheva, Francesco Di Bello, Giulio Avesani, Michael Baboudjian, Eric Barret, Alberto Breda, Alberto Briganti, Lars Budäus, Eva Comperat, Romain Diamand, Gert De Meerleer, Maarten De Rooij, Francesco Giganti, Gianluca Giannarini, Karolien Goffin, Jonathan Hernández Mancera, Barbara Alicja Jereczek-Fossa, Veeru Kasivisvanathan, Claudia Kesch, Laurence Klotz, Giovanni Lughezzani, Bernard Malavaud, Caroline Moore, Declan Murphy, Daniela Oprea-Lager, Anwar Padhani, Valeria Panebianco, Guillaume Ploussard, Antti Rannikko, Maria Rosalia Raspollini, Jystina Rembak-Szynkiewicz, Ivo Schoots, Simon Spohn, Armando Stabile, Deria Tilki, Alison Tree, Jochen Walz, Steven MacLennan, Francesco Sanguedolce, EAU Section of Urological Imaging
Fundació Puigvert, Dept. of Oncological Urology, Barcelona, Spain; Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Fundació Puigvert, Dept. of Oncological Urology, Barcelona, Spain., San Raffaele Scientific Institute, Dept. of Urology, Milan, Italy., Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Urology, Marseille, France., Institut Mutualiste Montsouris, Department of Urology, Paris, France., Fundació Puigvert, Dept. of Oncological Urology, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain., Urological Research Institute, Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy., Martini-Klinik Prostate Cancer Center and Dept. of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Medical University Vienna, Department of Pathology, General Hospital, Vienna, Austria., Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Department of Urology, Brussels, Belgium., University Hospital Leuven, Department of Radiation Oncology, Leuven, Belgium., Radboud University Medical Center, Department of Medical Imaging, Nijmegen, The Netherlands., University College London Hospitals NHS Foundation Trust, Department of Radiology, London, United Kingdom; University College London, Division of Surgery and Interventional Science, London, United Kingdom., Santa Maria della Misericordia University Hospital & University of Udine, Urology Unit, Udine, Italy., University Hospital Leuven, Nuclear Medicine, Leuven, Belgium; KU Leuven, Nuclear Medicine & Molecular Imaging, Department of Imaging and Pathology, Leuven, Belgium., Fundació Puigvert, Dept. of Radiology, Barcelona, Spain., University of Milan, Dept. of Oncology and Hemato-oncology, Milan, Italy; IEO European Institute of Oncology IRCCS, Dept. of Radiation Oncology, Milan, Italy., University College London, Division of Surgery and Interventional Science, London, United Kingdom; University College London Hospitals NHS Foundation Trust, Department of Urology, London, United Kingdom; University College London, Centre for Urology Imaging, Prostate, AI and Surgical Studies (COMPASS) Research Group, Division of Surgery and Interventional Science, London, United Kingdom., University Hospital Essen, Department of Urology, Essen, Germany., Sunnybrook Health Sciences Centre, Dept. of Urology, Toronto, Canada., Humanitas University & Humanitas Research Hospital (IRCCS), Dept. of Urology, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele (MI), Italy., Institut Universitaire du Cancer Toulouse-Oncopôle, Department of Urology, Toulouse, France., University College London, Division of Surgery and Interventional Science, London, United Kingdom; University College London Hospitals NHS Foundation Trust, Department of Urology, London, United Kingdom., Peter MacCallum Cancer Centre, Dept. of Urology, Melbourne, Australia., Mount Vernon Cancer Centre, Dept. of Radiology, Northwood, United Kingdom., Sapienza University of Rome, Department of Radiological Sciences, Oncology and Pathology, Rome, Italy., UROSUD, Clinique La Croix du Sud, Department of Urology, Quint-Fonsegrives, France., Helsinki University Hospital, Department of Urology, Helsinki, Finland; University of Helsinki, Research Program in Systems Oncology, Research Programs Unit, Faculty of Medicine, Helsinki, Finland; ICAN-Digital Precision Cancer Medicine Flagship, Helsinki, Finland., University Hospital Careggi, Histopathology and Molecular Diagnostics, Florence, Italy., Maria Sklodowska-Curie National Research Institute of Oncology, Radiology and Diagnostic Imaging Department, Gliwice Branch, Poland., Erasmus MC, Department of Radiology & Nuclear Medicine, Rotterdam, The Netherlands., Medical Center - University of Freiburg, Faculty of Medicine, Department of Radiation Oncology, University of Freiburg, Germany., Martini-Klinik Prostate Cancer Center and Dept. of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; University Hospital Hamburg-Eppendorf, Department of Urology, Hamburg, Germany; Koc University Hospital, Department of Urology, Istanbul, Turkey., The Royal Marsden National Health Service Foundation Trust, Uro-Oncology Unit, London, United Kingdom., Institute Paoli-Calmettes Cancer Center, Department of Urology, Marseille, France., University of Aberdeen, Academic Urology Unit, Aberdeen, United Kingdom., Fundació Puigvert, Dept. of Oncological Urology, Barcelona, Spain; Universitá degli Studi di Sassari, Department of Medicine, Surgery and Pharmacy, Sassari, Italy. Electronic address: .